engleski

Perforated retroperitoneal retrofascial sigmoid diverticulitis as a cause of osteomyelitis and septic necrosis of the acetabulum and proximal femur

Psoas muscle abscess is a rare entity with an estimated worldwide incidence of 12 cases annually, 20% occurring in persons over 40 (1). Primary abscesses are caused by hematogenous spread from distant infection mostly due to an unrecognized Staphylococcal septicaemia in 88.4% (2). They occur predominantly in younger patients and in developing or tropical countries. The secondary type is caused by contiguous infections from various sites with primary pathology. Prior to antituberculous therapy, mostly it was a complication of tuberculosis of the spine or sacroiliac joints. Today in 80% of patients the cause is gastrointestinal pathology. It is mostly due to Crohn’s disease (up to 73%) followed by appendicitis (16%), ulcerative colitis, diverticulitis and colon cancer (together 11%) with predominantly mixed infections (55.7%), mostly with E. coli and Bacteroides spp. Right-sided predilection occurred in 58% to 68% of patients and bilateral abscesses are rare, less than 3% (2), with higher percentage in severe diabetics (3).

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