From the Guidelines
A large psoas abscess typically requires drainage, and percutaneous catheter drainage (PCD) is often the preferred method, as it has been shown to result in rapid clinical improvement and high success rates, ranging from 70% to 90% 1. This approach is supported by the American College of Radiology, which recommends PCD for mature abscesses, including those associated with appendicitis, as an initial combination of PCD, antibiotics, bowel rest, and occasionally hyperalimentation has been advocated 1. The key benefits of PCD include:
- Rapid clinical improvement
- High success rates
- Lower rate of complications compared to operative management
- Shorter hospital stay In addition to drainage, appropriate antibiotic therapy is essential and should be started empirically, then adjusted based on culture results, with common empiric regimens including vancomycin plus piperacillin-tazobactam, or meropenem, typically continued for 2-6 weeks depending on clinical response and the underlying cause. However, it's worth noting that if percutaneous drainage is not feasible or not available, antibiotic therapy alone can be considered as an initial treatment, but careful clinical monitoring is mandatory 1. Overall, the goal of treatment is to prevent complications, such as sepsis, spread of infection to adjacent structures, and other complications, and to ensure complete resolution of the abscess.
From the Research
Treatment Options for Psoas Abscess
- The treatment of a psoas abscess depends on various factors, including the size of the abscess and the patient's overall health 2, 3, 4.
- Percutaneous catheter drainage (PCD) under imaging guidance, combined with broad-spectrum antibiotics, is considered the first-line treatment for psoas abscess 2, 3, 4.
- Surgical drainage, including open surgery or laparoscopic drainage, may be considered if PCD fails or is impossible 2, 3, 4.
- Laparoscopic drainage is a minimally invasive treatment option that offers complete drainage, resection of infected tissue, and treatment of concomitant lesions 2.
Large Psoas Abscess
- A large psoas abscess may require drainage, and the choice of treatment depends on the individual case 3, 4.
- Open surgery may be reserved for very large abscesses or cases where PCD is not possible 3.
- However, some studies suggest that percutaneous drainage can be effective even for large abscesses 4, 5.
- The median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group in one study 4.