Introduction: Iliopsoas abscess (IPA) represents a rare but clinically significant condition characterized by the accumulation of pus within the iliopsoas muscle, often resulting from hematogenous dissemination of distant infected sites or contiguous spread from a local focus. The management of IPA typically involves a combination of medical therapy via broad-spectrum antibiotic therapy, at times in combination with percutaneous or surgical drainage of a substantial focus.
Methods: We retrospectively reviewed 100 consecutive cases of iliopsoas abscess which were managed at the Swedish Neuroscience Institute between 2015 and 2024. Information was collected and analyzed regarding patient demographics, medical history, clinical/imaging/laboratory characteristics, selected treatment, hospital course, and patient outcomes.
Results: Of the 100 patients in our study cohort, 86 presented with back or flank pain, 45 had abdominal pain, and 35 had lower extremity discomfort. S. Aureus and E. Coli were the most common organisms isolated in cultures (38% and 31% respectively). Mean age of patients was 56 years (range 14-95). Among patients with IPA, 29% had concomitant inflammatory intra-abdominal disease, 25% had bacteremia, and 32% were identified as active IV drug users. Antibiotic therapy alone was instituted in 21 patients, and yielded successful outcomes in 16 of them, whereas the remaining 5 required subsequent IR drainage. Percutaneous CT guided drainage (PCD) was performed in 72 patients, of whom 32 had successful treatment of their abscess. In this subgroup, 12 required a repeat IR- drainage procedure, and 28 went on to undergo conventional surgery. Primary open surgical drainage was carried out in 7 patients. The mean hospital stay across the entire cohort was 21 days, and the observed overall mortality was 5%.
Conclusion : Antibiotic therapy and percutaneous drainage are first-line treatments for iliopsoas abscesses. Surgical intervention should be reserved for complex loculated IPA, as well as those that show gas formation on imaging, or those that affect the neurological exam, or are in proximity with vertebral elements or spinal instrumentation, or those that failed first line treatment.
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