Pelvic Abscess with Presentation as Inability to Ambulate

Abstract

Intra-abdominal abscesses are localized collections of pus confined in the peritoneal cavity by an inflammatory barrier. They are generally classified as intraperitoneal, retroperitoneal, or visceral and develop after perforation of a hollow viscus or by extension of infection or inflammation resulting from other conditions such as appendicitis or diverticulitis. Intra-abdominal abscesses are highly variable in presentation and clinicians must have a broad differential to avoid an inaccurate diagnosis. In this paper, presenting clinical symptoms as well as diagnosis and treatment methods are discussed in the context of this atypical presentation of a pelvic abscess. This retrospective case report presents a male patient in his early 60s who presented to the emergency department with atypical symptoms of a pelvic abscess. The author obtained all diagnostic information from patient interview and electronic health record. The patient’s history of end stage renal disease and diverticulitis with colostomy placement led to this atypical presentation of an intra-abdominal abscess. The patient’s abscess abutted the iliopsoas muscle that had given rise to his referred bilateral hip pain. This report presents a case of a male in his early 60s who presented to the hospital with complaint of bilateral hip pain and inability to ambulate. Providers admitted him to an internal medicine service and he was diagnosed with a recurrent pelvic abscess extending to his left iliopsoas muscle. Completed studies had failed to demonstrate any intrinsic pathology to the hips themselves. This case demonstrated an atypical presentation of a pelvic abscess, but brought up the theory that the etiology of the symptoms could be due to referred pain to the hips from the abscess. Further studies are required to investigate the percentage of pelvic abscess patients who primarily present with a component of hip pain.