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Thigh abscess as an extension of psoas abscess: the first manifestation of perforated appendiceal adenocarcinoma: case report

Hüftabszess als Ausdehnung eines Psoasabszesses – erste Manifestation eines perforierten Adenokarzinoms des Appendix: Fallbericht

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Summary

A 65-year-old woman presented with a painful, swollen, red right thigh and the mild pain in the right abdomen without nausea, vomiting or diarrhoea that lasted for 1 week. Laboratory findings revealed elevated inflammatory markers. Computed tomography of the right thigh, abdomen and pelvis showed an abscess formation in the adductor muscles draining from the abscess that completely occupied the right retroperitoneum up to the diaphragm, dissecting downward through the inguinal canal. Appendix was enlarged with an appendicolith. Emergent exploratory laparotomy revealed a perforated appendix with psoas abscess. Pathohistological diagnosis revealed adenocarcinoma of the appendix. Thigh abscess is an uncommon condition with insidious clinical presentation. Therefore, early recognition and setting of the correct diagnosis enables adequate treatment avoiding additional complications and in some cases potential life-threatening conditions. When upper leg abscess is suspected or proven abdominal examination is mandatory.

Zusammenfassung

Eine 65-jährige Frau präsentierte sich mit einer seit einer Woche schmerzhaften, geschwollenen rechten Hüfte und geringen Schmerzen im rechten Abdomen ohne Nausea, Erbrechen oder Diarrhoe. Im Labor waren die Entzündungsmarker erhöht. Die Computertomographie der rechten Hüfte, des Abdomens und Beckens zeigte eine Abszessbildung in den Adduktoren als Drainage von einem Abszess, der das rechte Retroperitoneum bis zum Diaphragma ausfüllte und hinunter durch den Inguinalkanal dissezierte. Der Appendix war vergrößert mit einem Appendikolithen. Die explorative Not-Laparatomie ergab einen perforierten Appendix mit einem Psoasabszess. Pathohistologisch wurde ein Adenokarzinom des Appendix befundet. Hüftabszesse sind selten und präsentieren sich klinisch schleichend. Deshalb sind das frühe Erkennen und die frühe Erstellung der korrekten Diagnose wichtig. Nur so kann eine adäquate Therapie unter Vermeidung von zusätzlichen Komplikationen und manchmal sogar lebensbedrohenden Zuständen ermöglicht werden. Wenn der Verdacht eines Abszesses im Oberschenkel besteht oder dieser bestätigt ist, muss unbedingt eine Untersuchung des Abdomens durchgeführt werden.

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Conflict of interest

The authors declare they have no conflict of interest.

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Authors and Affiliations

  1. Division of Abdominal Surgery, Clinical University Hospital Centre “Zagreb”, Kispaticeva 12, 10000, Zagreb, Croatia

    Igor Petrovic MD, PhD, Goran Augustin MD, PhD & Ante Gojevic MD, PhD

  2. Department of Internal Medicine, Clinical University Hospital Centre “Zagreb”, Kispaticeva 12, 10000, Zagreb, Croatia

    Ivan Pecin MD & Zeljko Reiner MD, PhD

  3. Department of Radiology, Clinical University Hospital Centre “Zagreb”, Kispaticeva 12, 10000, Zagreb, Croatia

    Maja Prutki MD, PhD & Kristina Potocki MD, PhD

  4. Department of Internal Medicine, General Hospital Virovitica, Gajeva 21, 33000, Virovitica, Croatia

    Ana Nedic MD

Authors
  1. Igor Petrovic MD, PhD
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  2. Ivan Pecin MD
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  3. Maja Prutki MD, PhD
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  4. Goran Augustin MD, PhD
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  5. Ana Nedic MD
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  6. Ante Gojevic MD, PhD
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  7. Kristina Potocki MD, PhD
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  8. Zeljko Reiner MD, PhD
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Corresponding author

Correspondence to Ana Nedic MD.

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All human and animal studies have been approved by appropriate ethics committee. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration 1975, as revised in 2008.

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Petrovic, I., Pecin, I., Prutki, M. et al. Thigh abscess as an extension of psoas abscess: the first manifestation of perforated appendiceal adenocarcinoma: case report. Wien Klin Wochenschr 127, 645–648 (2015). https://doi.org/10.1007/s00508-014-0651-0

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  • DOI: https://doi.org/10.1007/s00508-014-0651-0

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