Iliopsoas abscess: A clinical dilemma — case report
Keywords:Iliopsoas abscess, Crohn's Disease, Intestinal tuberculosis
Iliopsoas abscess (IPA) is the accumulation of pus inside the iliopsoas muscle compartment. The early stages of its clinical presentation are often non-specific and therefore incidentally diagnosed with computed tomography. We describe the case of a 27-year-old man with a history of Crohn’s disease presenting with right-sided lower back pain radiating downwards to the lateral part of his thigh and exacerbated with hip movement. Examination of the patient showed a cachectic physique with a fixed flexion deformity at the right hip with a positive psoas sign. We further report the clinical dilemma on the diagnosis between Crohn’s disease and intestinal tuberculosis and the subsequent management of IPA secondary to Crohn’s disease. Our patient was managed with a loop ileostomy for bowel rest with continuous abscess draining and discharged after 3 months. After the reversal of ileostomy, the patient was satisfied with the overall outcomes. The clinical dilemma stems from the rising incidence of Crohn’s disease in Malaysia, as the clinical presentation of intestinal tuberculosis and Crohn’s disease is similar. Therefore, it is important for countries transitioning to higher income groups to be able to suspect and treat the condition accordingly.
Mallick H, Thoufeeq MH, Rajendran TP. Iliopsoas abscess. Postgrad Med J. 2004;80:459-62. 10.1136/pgmj.2003.017665
Yeh PH, Jaw WC, Wang TC, Yen TY. Evaluation of iliopsoas compartment disorders by computed tomography. Zhonghua Yi Xue Za Zhi(Taipei). 1995;55(2):172-9. PMID: 7750059.
Matson M, Ahmad M, Power N. Diagnostic imaging. In: Norman W, O’Connell RP, McCaskie AW, eds. Bailey & Love’s Short practice of surgery. 27th ed. Portland: CRC press; 2018. Pp. 212.
Jerome AL, Kuijper EJ, Prins JM etal. Tuberculin skin testing is useful in the screening for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clinical Infectious Disease. 2006;43:1547-51.
Prabhu PR, Mayank J, Piyush B, Varghese J, Venkataraman J. Role of Colonoscopy in differentiating Intestinal tuberculosis from Crohn’s disease. Journal of Digestive Endoscopy. 2017;8(2): 72-7. 10.4103/jde.JDE_13_17
Arzu NZ, Sezai T, Cengiz C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulomonary and extrapulmonary specimens. J Clin Microbiol. 2011;49(12):4138-41. 10.1128/JCM.05434-11
Apps.who.int. (2018). GHO | By category | Incidence - Data by country. [online] Available at: https://apps.who.int/gho/data/view.main.57040ALL?lang=en.
Hilmi I, Jaya F, Chua A, Wong CH, Singh H and Goh KL. A first study on the incidence and prevalence of IBD in Malaysia—results from the Kinta Valley IBD Epidemiology Study. J Crohns Colitis. 2015;9(5):404-9. 10.1093/ecco-jcc/jjv039
Ng SC, Tang W, Ching JY, Wong M, Chung MC, Hui AJ, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study. Gastroenterology. 2013;145(1):158-65. 10.1053/j.gastro.2013.04.007
Hilmi I, Tan YM, Goh KL. Crohn’s disease in adults: observations in a multiracial Asian population. World J Gastroenterol. 2006;12(9):1435-8. 10.3748/wjg.v12.i9.1435
Rheenen PF, Vijver EV, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;341:c3369. 10.1136/bmj.c3369
Larsson G, Shennoy KT, Ramasubramaniam R, Thayumanavan L, Balakumaran LK, Bjune GA, et al. High faecal calprotectin levels in intestinal tuberculosis are associated with granulomas in intestinal biopsies. Infect Dis (Lond). 2015;47(3):137-43. 10.3109/00365548.2014.974206
Navaneethan U, Cherian JV, Prabhu R, Venkataraman J. Distinguishing Tuberculosis and Crohn’s Disease in developing countries: How certain can you be of the diagnosis? Saudi J Gastroenterol. 2009;15(2):142-4. 10.4103/1319-3767.49012
Wu YF, Cheng MH, Yuan CT, Chen CN. Intestinal tuberculosis previously mistreated as Crohn’s disease and complicated with perforation: a case report and literature review. Springer plus. 2015;4:326. 10.1186/s40064-015-1129-x
Hilmi I, Roslani AC, Goh KL. Management of IBD in Malaysia. IBD research. 2015;9(3):180-7.
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