Management of paediatric psoas abscess: our experience

Abstract

Background: Ilio-psoas abscess (IPA) is uncommon in children. It has varied clinical presentation causing difficulties in diagnosis. We present our experience with management of psoas abscess in 23 children.

Materials and methods: Records of 23 patients managed at a tertiary institute between March 2011 and December 2016 were reviewed and retrospectively analysed on the basis of age at presentation, presenting complaints, clinical and radiological findings and management.

Results: Age of presentation ranged between 20 days and 11 years. Most of the patients presented with fever (n = 20) followed by abdominal pain (n = 11), hip pain (n = 9) and back pain (n = 6). Abscess volume ranged from 20 ml to 300 ml. Ten patients with unliquified abscesses were managed by intravenous antibiotics. Six patients underwent USG-guided aspiration of abscesses (volumes: 20 ml to 150 ml). Pigtail catheter was inserted in 7 patients with partially liquefied abscesses of volume 150 to 300 ml. Clinical response was rapid. The catheter was removed after drainage was stopped and USG confirmed the absence of residual collection. The 15 patients with fixed flexion deformity underwent skin traction. Bacteriological examination was performed in 13 patients – there was no growth in 4 patients, methicillin-resistant Staphylococcus aureus (MRSA) in 1 patient, methicillin-sensitive Staphylococcus aureus (MSSA) in 6 patients and acid-fast bacilli (AFB) in 2 patients.

Conclusion: IPA is a rare disease in children. Intravenous antibiotics covering S. aureus and image-guided percutaneous drainage are effective in managing most patients. Open drainage is required if percutaneous drainage fails to completely resolve the abscess and clinical symptoms deteriorate despite antibiotic treatment.