文献考察:腸腰筋膿瘍psoas abscess
1)Abdom Imaging. 2001 Sep-Oct;26(5):533-9. Iliopsoas abscess: a report of 24 patients diagnosed by CT.
Zissin R, Gayer G, Kots E, Werner M, Shapiro-Feinberg M, Hertz M.
BACKGROUND: We wanted to define the role of computed tomography (CT) in the diagnosis, etiology, and treatment of iliopsoas abscess. METHODS: Twenty-four patients (18 men, six women; age range = 17-86 years) with iliopsoas abscesses diagnosed over 8 years were retrospectively reviewed. All presented with fever and elevated white blood cell counts. Twenty-one had abdominal, flank or pelvic pain and nine had specific psoas signs suggesting the diagnosis. RESULTS: Seventeen of the abscesses were right-sided. Twenty were regarded as secondary to various underlying causes that were clearly demonstrated on CT and related to gastrointestinal (n = 12), skeletal (n = 5), or urinary tract (n = 3) diseases. All patients received appropriate antibiotic treatment. Thirteen also had their abscesses drained and eight had definitive surgical procedures. CONCLUSION: CT is an effective imaging technique for diagnosing iliopsoas abscess, even when classic clinical signs are absent. Treatment by percutaneous drainage under CT guidance is another advantage. When a psoas abscess is a complication of Crohn's disease, resection of the affected bowel segment is recommended in addition to drainage because drainage alone even in conjunction with appropriate medical therapy is usually not effective. PMID: 11503095
2)高齢者に発症した腸腰筋膿瘍の1例(原著論文/症例報告)
Author:山本俊信(名古屋市厚生院), 山腰雅宏, 鈴木幹三, 他
Source:感染症学雑誌(0387-5911)70巻4号 Page371-376(1996.04) 要旨:著者らの,1990年から5年間の82例の集計によると,平均年令は48.8歳,男女比は52:30,発生部位は右42例,左29例,両側性11例である.基礎疾患は糖尿病が14例と最も多く,次いで尿路結石4例,腎不全などの腎疾患3例,Crohn病3例(欧米ではもっと多い),大腸癌2例であった.起炎菌はstaphylococcus aureusが27例と最も多く,E.coli.8例,bacteroides属6例の順であった.死亡例は6例(7.3%)で,高齢者と,糖尿病,肝硬変,腎不全などの基礎疾患を有する全身状態不良例では予後が悪い.
腸腰筋膿瘍は,原因不明の原発性(primary)と,隣接臓器の感染から波及した続発性(secondary)に分類される.原発性は比較的若年者の男性に多く,起炎菌はstaphylococcusが圧倒的に多い.続発性は消化器からの感染が多いので起炎菌はE.coli.とbacteroidesが多く,死亡率も原発性より高い.
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