Psoas abscess following acute appendicitis due to Proteus mirabilis and Klebsiella pneumoniae
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64 Hellenic Journal of Surgery 2013; 85: 1
Psoas Abscess Following Acute Appendicitis Due to Proteus Mirabilis and Klebsiella Pneumoniae Case Report N. Zacharis, M. Gavana, E. Karagkouni, C. Potsios, P. Xaplanteri, G. Zacharis Received 24/10/2012 Accepted 18/11/2012
Abstract The common sites of abscess formation complicating perforated acute appendicitis are well known. However, localization of these abscesses to the psoas muscle is rare. In our case, a 36-year-old black male refugee attended the emergency department of our hospital complaining of abdominal pain after falling from a truck. His history revealed two former operations on the lower abdomen performed in Sudan. Computerized tomography of the abdomen that followed displayed the formation of a psoas abscess. As a result, the patient underwent exploratory laparotomy which identified perforation of the appendix retroperitoneally. A culture of the abscess specimen disclosed the presence of Klebsiella pneumoniae and Proteus mirabilis. In addition to describing this case, we also briefly review the literature for retroperitoneal psoas abscesses.
Key words:
Psoas abscess, Appendicitis, CT, Klebsiella pneumoniae, Proteus mirabilis
Introduction Most surgeons think of psoas abscess as an extremely rare condition related to spine tuberculosis. In contemporary surgical practice, psoas abscesses are more usually a complication of gastrointestinal disease [1]. Iliopsoas abscess is a relatively rare disease. Many
N. Zacharis (Corresponding author) - GP, Internal Medicine, Patras, Greece G. Zacharis - Department of General Surgery, St. Andrew’s General Hospital, Patras, Greece M. Gavana, E. Karagkouni - Department of Radiology, St. Andrew’s General Hospital, Patras, Greece C. Potsios - Kalavryta General Hospital, Kalavryta, Greece P. Xaplanteri - Technological Educational Institute of Patras, Microbiology Laboratory, Patras, Greece e-mail: [email protected]
cases present atypical clinical characteristics. Iliopsoas abscess can be primary or secondary to gastrointestinal and genitourinary infections. In developed countries, most of these abscesses are of non-tuberculous aetiology. A high index of clinical suspicion, the past and recent history of the patient and imaging studies can be helpful in diagnosing the disease[3]. Early treatment with drainage, surgery or appropriate antibiotic therapy is necessary before sepsis become lethal.
Case presentation Written informed consent has been obtained from the patient, for the publication of his personal data. A 36-year-old black male refugee attended the emergency department presenting abdominal pain, subfebrile temperature and weakness after falling from a truck. His history revealed two surgeries on the abdomen performed in Sudan. The patient was unable to explain the reason for the surgeries. Physical examination revealed abdominal distention, guarding and rebound tenderness on palpation of the right iliac fossa. Rectal digital examination was negative for blood. The body temperature was 38,20C. Laboratory t
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