A CASE OF CROHN'S DISEASE PRESENTED WITH PSOAS ABSCESS

Abstract

It is rare that Crohn's disease is associated with a psoas abscess, and there have been only nine such cases in Japan as far as we could review. A case of Crohn's disease presented with a psoas abscess is reported, together with a review of the literature.
A 29-year-old man undergoing an ambulatory treatment for a pain of the right hip joint at another hospital was referred to the hospital because of strong tenderness in the right lower abdomen. The patient was diagnosed as having a psoas abcess by a CT scan, and underwent drainage and an appendectomy. After the operation, exacerbation of the abscess was confirmed. Re-laparotomy and drainage were conducted, but an efflux of intestinal fluid from the drain was noted. Barium enema study revealed a severe stricture and abscess vavity at the terminal ileum, and so Crohn's disease of the small intestine was a most likely diagnosis. After conservative therapy was unsuccessful, an excision ofthe ileocecal region was performed. The excised material showed longitudinal ulcer. The definite diagnosis of Crohn's disease was made.
In the treatment of psoas abscess when exacerbation of the abscess or fistula formation is confirmed, Crohn's disease should be actively suspected, and once the diagnosis of Crohn's disease is obtained, the excision of the lesion would be desirable.