Les abcès du psoas: aspects diagnostic et therapeutique Abscess of the psoas: diagnostic and therapeutic aspects

Objective : Abscess of the psoas which was first described by Mynter in 1881 1 is a rare disease. Herein, the authors report on their experience with the treatment of this pathology. Patients and Methods : Between January 1999 and December 2002, 15 patients with abscess of the psoas were seen at our department. They were 12 males (80%) and 3 females (20%) with a mean age of 53 years (range: 27 – 70 years). Mean hospital stay was 6 weeks (range: 2 – 24 weeks). All patients were examined by abdominal ultrasonography, 9 by computed tomography. Surgical drainage via a small incision of 5 cm was done in 12 patients, while three patients received medical treatment in combination with a percutaneous drainage. Results : The clinical manifestation included fever in 9 (60%), psoitis in 6 (40%), a mass in the lumbar region in 5 (33%) and an inguinal mass in 3 (20%) patients. Hyperleucocytosis varying between 13000 and 340000/mm 3 was found in all patients. The main organisms isolated were staphylococcus aureus (54%), Koch's bacillus (38.4%), Escherichia coli (15%) and Klebsiella (8%). De novo abscess of the psoas was found in 4 patients (26.6%), while it was secondary in 11 patients (73.3%). Surgical drainage of the pus was done via the anterolateral extraperitoneal lumbar approach in 8 patients and via the high inguinal approach in 4 patients. In three patients medical treatment combined with percutaneous drainage was sufficient. The immediate outcome was good in all patients. Conclusion : The pathogenesis of de novo abscess of the psoas is unknown as yet, and its diagnosis remains a challenge for the physician. However, the precise clinical diagnosis and the choice of the therapeutic measures have been facilitated by the development of modern imaging facilities. Surgical treatment should be reserved to those cases where percutaneous drainage has failed. Resume Objectif : Decrit pour la premiere fois en 1881 par Mynter 1 , l'abces du psoas est une maladie rare. Les auteurs rapportent leur experience dans la prise en charge de cette pathologie. Patients et methodes : De janvier 1999 jusqu'en decembre 2002, quinze observations d'abces du psoas, 12 hommes (80%) et 3 femmes (20%), d'âge moyen de 53 ans (27 - 70 ans), ont ete colligees dans notre service. Le delai moyen d'hospitalisation est de 6 semaines (2 semaines - 24 semaines). L'interrogatoire permettait de reconstituer l'histoire de la maladie et une enquete etiologique. Tous les patients ont ete explores par le couple abdomen sans preparation et echographies abdominales. Neuf patients ont eu un uro-scanner. Le drainage chirurgical par une petite incision de 5 cm a ete effectue chez 12 patients. Le traitement etiologique a ete realise ulterieurement chez 9 patients. Resultats : La symptomatologie clinique etait faite de fievre chez 9 malades (60%), d'un psoitis chez 6 malades (40%), d'une masse lombaire chez 5 malades (33%) et d'une masse inguinale chez 3 malades (20%). Une hyperleucocytose oscillant entre 13000 et 34000 /mm 3 a ete trouvee chez tous les malades (54%). Les germes les plus frequemment isoles sont le staphylocoque dore (54%), le bacille de Koch (38,4%), Escherichia coli (15%) et Klebsiella (8%). L'abces du psoas etait primitif chez 4 malades (26.6%) et secondaire chez 11 malades (73.3%). Le traitement chirurgical qui consiste a drainer largement la collection purulente a ete realise chez 8 malades par voie lombaire anterolaterale extra peritoneale et par voie inguinale haute chez 4 malades. Trois de nos malades ont bien evolue sous traitement medical associe a un drainage percutane. L'evolution immediate est favorable chez tous nos malades. Conclusion : L'abces primitif du psoas reste de pathogenie obscure. C'est un piege diagnostique pour le clinicien. Le diagnostic clinique precis de l'abces et la sanction therapeutique ont beneficie des donnees recentes de l'imagerie moderne. Le traitement chirurgical reste la reference en cas d'echec du drainage percutane. African Journal of Urology Vol. 11(4) 2005: 319-322