REVIEW ARTICLE


A Devasting Course of an Iliopsoas Muscle Abscess Subsequently Leading to Septic Shock, Septic Hip Arthritis, and Extended Gluteal Soft Tissue Necroses in an Elderly Immunocompromised Patient with Multiple Carcinomas: A Case Report and Brief Review of Literature



Ingo Schmidt*
Med. Versorgungszentrum Bad Salzungen GmbH (Betriebsstätte Wutha-Farnroda), Lindigallee 3, 36433 Bad Salzungen, Germany


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© 2018 Ingo Schmidt.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Med. Versorgungszentrum Bad Salzungen GmbH (Betriebsstätte Wutha-Farnroda), Lindigallee 3, 36433 Bad Salzungen, Germany; E-mail: schmidtingo62@googlemail.com


Abstract

Background:

A devasting course of Iliopsoas Muscle (IPM) abscess remains a challenging therapeutic problem.

Methods:

A 69-year-old polymorbid male had a history of multiple carcinomas and presented with advanced stage of septic shock due to a right IPM abscess which communicated with the right hip joint and subsequently led to septic hip arthritis accompanied with post-infectious right gluteal deep soft tissue necroses. Management of surgical treatment included abscess revision, coverage with the use of Long Head Biceps Femoris Muscle (LHBFM) 180° turnover flap, and creating a Girdlestone resection-arthroplasty.

Results:

After a duration of patient's hospitalization of six months that included the necessity of artificial respiration over two months accompanied with in summary 18 required surgical procedures, the patient could be recovered successfully regarding his polymorbidity and his low-demand claims in activities of daily living with his Girdlestone resection-arthroplasty.

Conclusion:

Recovery of immunocompromised patients with those life-threatening situations can only be achieved by an interdisciplinary management. The LHBFM 180° turnover flap can be useful for filling off post-infectious deep soft tissue cavities communicating with the hip joint. The definitive Girdlestone resection-arthroplasty for treatment of septic hip arthritis is the method of choice for mobilization of elderly polymorbid patients with low demand claims in their activities of daily living.

Keywords: Iliopsoas muscle abscess, Septic shock, Septic hip arthritis, Soft tissue defect, Girdlestone resection-arthroplasty, Coverage, Biceps femoris muscle turnover flap.