BACKGROUND: Iliopsoas abscess (IPA) is a rare but serious condition caused by hematogenous or contiguous spread of infection. Management typically involves broad-spectrum antibiotics, with percutaneous or surgical drainage for larger abscesses.
METHODS: We retrospectively reviewed 113 IPA cases at the Swedish Neuroscience Institute (2015-2024), analyzing demographics, clinical features, imaging, treatment strategies, hospital course, and outcomes.
RESULTS: Among 100 patients included, 86 presented with back or flank pain, 45 with abdominal pain, and 35 with lower extremity discomfort. The most common pathogens were Staphylococcus aureus (38%) and Escherichia coli (31%). Mean patient age was 56 years (range: 32-71); 29% had intra-abdominal inflammatory disease, 25% had bacteremia, and 32% were intravenous drug users. Antibiotics alone were successful in 16/21 patients (76%), while 5 (24%) required subsequent CT-guided percutaneous drainage (PCD). Among 72 patients undergoing PCD, 32 (44%) had successful treatment, 12 (17%) required multiple procedures, and 28 (39%) underwent surgery after failed drainage. Primary surgical drainage was performed in 7 patients (7%). Mean hospital stay was 21 days, and overall mortality was 5%, lower than reported rates (5%-15%).
CONCLUSIONS: First-line treatment for IPA includes antibiotics and PCD, with surgery reserved for complex cases, gas formation, neurological involvement, proximity to vertebrae or spinal hardware, or failure of initial treatment.