Zafar S et al, 2018: Bilateral Psoas Abscess After Extracorporeal Shock Wave Lithotripsy: Reminder Of A Rare Complication.
Zafar S, Bin Mahmood SU, Tharwani A, Nasir N.
Aga Khan University, Pakistan.
Yale University School of Medicine, New Haven, United States.
Extracorporeal shock wave lithotripsy (ESWL) is among the most widely used modalities for treatment of urolithiasis since its introduction in the 1980s. The non-invasive technique reduces the risk of post-procedure complications and produces excellent stone free rates. However, complications may still follow and albeit rare, there are reports in literature of abscess formation post ESWL. Herein, we report the case of a young, immunocompetent gentleman who developed bilateral psoas abscess after undergoing this procedure. He was successfully managed at our institute with intravenous antibiotics, percutaneous abscess drainage and was discharged on day 5 post-intervention in a stable condition. There have been two similar cases reported in literature.
J Ayub Med Coll Abbottabad. 2018 Jul-Sep;30(3):470-472.
The authors describe a very unusual complication of SWL. It is reported that bilateral stenting and SWL had been carried out before. One of the sessions approximately one month ago, but it is not mentioned on which side this treatment was done.
The CT-image (Figure 1) shows an obstructive stone in the left ureter or PUJ and that no stent remains in the system. My immediate interpretation is that the development of the psoas abscess is the result of rupture of the renal collecting system as a consequence of obstruction with retroperitoneal leakage of infected purulent urine. The authors’ explanation was that extravasation of infected blood had occurred.
Nothing is mentioned about the bacteriology (urine cultures) before SWL, but the described complication emphasizes the need of appropriate pre-treatment with antibiotics before SWL in case of positive urine cultures or a history of urinary tract infection.