我们经历了一个罕见的病例,其中髂腰肌脓肿(IPA),由产超广谱β-内酰胺酶(ESBL)的奇异变形杆菌引起,穿孔并与输尿管连通,导致败血症。一个84岁的女人,因脑出血后遗症卧床不起,被带到我们医院,主要投诉发烧持续3周。计算机断层扫描(CT)显示右髂腰肌巨大的180×110×100mmIPA。还发现输尿管与髂腰肌脓肿有交流,在同一部位检测到输尿管狭窄,肾盂扩张发生在输尿管狭窄区域上方,提示肾积水.考虑到这种情况的机制,如果输尿管首先破裂并且尿液泄漏,随后形成了IPA,尿液会沿着周围的脂肪组织流动,并在输尿管和肾脏周围引起脓肿。然而,因为输尿管周围几乎没有发现脓肿,脓肿被认为起源于输尿管中心附近的髂腰肌。总之,在这种情况下,脓肿首先在髂腰肌形成,逐渐扩张并压缩右输尿管,导致肾积水.输尿管上段,由于输尿管阻塞而变得扩张和变薄,由于IPA的炎症扩散,变得更加脆弱,IPA穿孔并与输尿管连通。在沟通困难的患者中,IPA的诊断可能会延迟,因为唯一的症状是发烧。在这种情况下,如果诊断延迟,脓肿可能会变大并穿孔输尿管;因此,IPA应始终被视为不明原因的发烧的原因。
We experienced a rare
case in which iliopsoas abscess (IPA), caused by an Extended Spectrum β-Lactamase (ESBL)-producing Proteus mirabilis, perforated and communicated with the ureter and caused sepsis. An 84-year-old woman, bedridden due to sequelae of a cerebral hemorrhage, was brought to our hospital with a chief complaint of fever lasting for 3 weeks. Computed tomography (CT) revealed a huge 180 × 110 × 100 mm IPA in the right iliopsoas muscle. The ureter was also found to communicate with the iliopsoas muscle abscess, ureteral stenosis was detected at the same site, and dilatation of the renal pelvis occurred above the area of the ureteral stenosis, indicating hydronephrosis. Considering the mechanism of this
case, if the ureter first ruptures and urine leaks, followed by the formation of an IPA, urine will flow along the surrounding fatty tissue and cause an abscess around the ureter and kidney. However, because almost no abscess was detected around the ureter, the abscess was thought to have originated from the iliopsoas muscle located near the center of the ureter. In summary, in this
case, an abscess first formed within the iliopsoas muscle, which gradually expanded and compressed the right ureter, resulting in hydronephrosis. The upper ureter, which had become dilated and thinned due to ureteral obstruction, became even more fragile because of the spread of inflammation from the IPA, and the IPA perforated and communicated with the ureter. In patients who have difficulty communicating, the diagnosis of IPA may be delayed because the only symptom is fever. As in this
case, if the diagnosis is delayed, the abscess may become large and perforate the ureter; thus, IPA should always be considered as a cause of fever of unknown origin.