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Iliopsoas Abscess (together with Bullet) Resulting from a Firearms Injury.

Güzel Y, Çiftçi S, Özdemir A, Acar MA - Case Rep Orthop (2015)

Bottom Line: One month later, the patient presented again to the polyclinic with a high temperature and back pain.The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed.At the 6-month follow-up examination, the patient had no complaints.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, School of Medicine, Ordu University, Campus of Cumhuriyet, Center, 52200 Ordu, Turkey.

ABSTRACT
Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints.

No MeSH data available.


Related in: MedlinePlus

MRI of accumulated suppurative fluid within the iliopsoas fascia.
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fig2: MRI of accumulated suppurative fluid within the iliopsoas fascia.

Mentions: At the follow-up examinations, the bullet entrance hole was seen to have closed without any problems and the patient was mobile. However, after 1 month the patient presented again to the Emergency Department with complaints of high temperature and pain in the back and on the right side and from the examination of magnetic resonance imaging (MRI) the diagnosis of IPA was made (Figure 2). Percutaneous drainage was applied under ultrasonography (USG) guidance. As there was production of Staphylococcus aureus on the drainage fluid, antibiotic treatment was started with advice of the Infectious Diseases Department. After the percutaneous drainage, the patient experienced relief of the complaints but then presented to the polyclinic 10 days later with the same complaints. In the laboratory test results, the erythrocyte sedimentation rate was 56 and C-reactive protein value was 47 and, on USG, abscess accumulation was again seen. Surgery was planned. The patient was placed in a lateral position and with an anterolateral incision and retroperitoneal approach the iliopsoas fascia was reached, the abscess was drained, culture was taken, and the bullet was removed (Figure 3). At the 6-month follow-up, the patient had no complaints and the infection markers were normal.


Iliopsoas Abscess (together with Bullet) Resulting from a Firearms Injury.

Güzel Y, Çiftçi S, Özdemir A, Acar MA - Case Rep Orthop (2015)

MRI of accumulated suppurative fluid within the iliopsoas fascia.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446483&req=5

fig2: MRI of accumulated suppurative fluid within the iliopsoas fascia.
Mentions: At the follow-up examinations, the bullet entrance hole was seen to have closed without any problems and the patient was mobile. However, after 1 month the patient presented again to the Emergency Department with complaints of high temperature and pain in the back and on the right side and from the examination of magnetic resonance imaging (MRI) the diagnosis of IPA was made (Figure 2). Percutaneous drainage was applied under ultrasonography (USG) guidance. As there was production of Staphylococcus aureus on the drainage fluid, antibiotic treatment was started with advice of the Infectious Diseases Department. After the percutaneous drainage, the patient experienced relief of the complaints but then presented to the polyclinic 10 days later with the same complaints. In the laboratory test results, the erythrocyte sedimentation rate was 56 and C-reactive protein value was 47 and, on USG, abscess accumulation was again seen. Surgery was planned. The patient was placed in a lateral position and with an anterolateral incision and retroperitoneal approach the iliopsoas fascia was reached, the abscess was drained, culture was taken, and the bullet was removed (Figure 3). At the 6-month follow-up, the patient had no complaints and the infection markers were normal.

Bottom Line: One month later, the patient presented again to the polyclinic with a high temperature and back pain.The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed.At the 6-month follow-up examination, the patient had no complaints.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, School of Medicine, Ordu University, Campus of Cumhuriyet, Center, 52200 Ordu, Turkey.

ABSTRACT
Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints.

No MeSH data available.


Related in: MedlinePlus