Immediately following the diagnosis of iliopsoas abscess,
prompt treatment is mandatory. After circulatory
stabilization and obtaining blood cultures, abscess drainage
and administration of appropriate intravenous antibiotics
are essential.24 Reports on successful treatment of
psoas abscess with antibiotic therapy and percutaneous
drainage are found;9,20 however, valid long-term results
on these techniques are not yet available. In our experience,
percutaneous abscess drainage can be a therapeutic
option in patients with high risk factors for operative
treatment. However, one of our patients with percutaneous
abscess drainage developed progression of spondylodiscitis
and recurrence of the abscess. For treatment of
chambered or multiloculated abscesses, a percutaneous
drainage is not sufficient.24 In primary psoas abscess,
open drainage via an extraperitoneal approach is the
treatment of choice.23 It allows sufficient and complete
abscess drainage and debridement of the abscess membrane,
resulting in a recovery rate up to 97%.23 Additional
advantages of the open drainage are a shorter hospital
stay and a lower recurrence rate.24 For secondary
psoas abscess, it is essential to combine abscess drainage
with causative treatment of the primary infectious focus.
7 Drainage alone may result in recurrence rates up to
50%.22,23 With infectious processes of the spine causing
psoas abscess, destructive infection of a vertebral body
or intervertebral space may lead to spinal instability.
Dorsal and ventral stabilization techniques are performed.
Infectious spreading from the spine to the cerebral
spinal fluid is very rare and severely worsens prognosis.
With infection after spinal surgery, an
instrumentation removal is often necessary to eradicate
infection and should be performed as long as stability is
guaranteed.11 Treatment strategies for tuberculous
psoas abscess include appropriate antituberculous therapy
and abscess drainage.4 The antituberculous medical
therapy is to be continued for a period of 6 –12
months.