PSOAS ABSCESS

PSOAS ABSCESS

1. Definition: A psoas abscess is a rare and serious condition characterized by a collection of pus in the psoas muscle, which is located along the spine.
2. Anatomical relation of psoas muscle:
   1. Located in the posterior abdominal wall
   2. Extends from the 12th thoracic vertebra to the 4th lumbar vertebra
   3. Adjacent to the spine, kidney, and retroperitoneal space
3. Spread of infection: → Infection enters the psoas muscle through the bloodstream or direct extension from adjacent structures → Bacteria multiply and cause inflammation, leading to abscess formation
4. Aetiologies:
   1. Tuberculosis (TB) - the most common cause
   2. Enteric infection (e.g., typhoid fever)
   3. Post-surgical infection
   4. Trauma or injury to the psoas muscle
   5. Infection from adjacent structures (e.g., spine, kidney)
5. Clinical features:
   1. Fever
   2. Flank pain
   3. Limp or stiffness in the hip or back
   4. Weight loss and fatigue
   5. Abdominal tenderness or guarding
6. Investigations:
   1. Complete blood count (CBC) - to detect infection or inflammation
   2. Erythrocyte sedimentation rate (ESR) - to detect inflammation
   3. C-reactive protein (CRP) - to detect inflammation
   4. Ultrasound - to detect fluid collection or abscess
   5. Computed tomography (CT) or magnetic resonance imaging (MRI) - to confirm abscess diagnosis and guide drainage
   6. Aspiration - to collect pus for culture and sensitivity testing
7. CT and MRI findings:
   1. Abscess formation in the psoas muscle
   2. Swelling and enhancement of the psoas muscle
   3. Fluid collection or abscess in the retroperitoneal space
8. Indications for drainage:
   1. Large abscess size (>5 cm)
   2. High fever or sepsis
   3. Failure of medical treatment
   4. Abscess progression or worsening symptoms
9. Surgical approaches for drainage:
   1. Open drainage - through a midline incision
   2. Percutaneous drainage - through a needle or catheter insertion
   3. Laparoscopic drainage - through a minimally invasive approach
10. Complications:
    1. Sepsis
    2. Deep vein thrombosis (DVT)
    3. Vertebral osteomyelitis (infection of the spine)
    4. Kidney or adrenal gland involvement
    5. Intestinal obstruction or perforation

HOMOEOPATHIC THERAPEUTIC MEDICINES

1. Arnica montana - for pain and inflammation
2. Belladonna - for fever and inflammation
3. Phytolacca - for abscess formation and inflammation
4. Silica - for abscess formation and inflammation
5. Thuja occidentalis - for abscess formation and inflammation
6. Ustilago maydis - for abscess formation and inflammation
7. Bryonia - for pain and inflammation
8. Colocynth - for pain and inflammation
9. Lycopodium - for abscess formation and inflammation
10. Sulfur - for abscess formation and inflammation

Indications:

• For abscess formation and inflammation: Phytolacca, Silica, Thuja occidentalis, Ustilago maydis
• For pain and inflammation: Arnica montana, Belladonna, Bryonia, Colocynth
• For abscess formation and inflammation: Lycopodium, Sulfur