Psoas Abscess Presenting as a Cause of Small Bowel Obstruction in an Adult: A Diagnostic Challenge

Introduction: Iliopsoas Abscess is a rare condition with non - specific presenting complaints. The disease symptoms are subtle, the etiology is variable and its presentation is atypical in a lot of cases. Only 30% of cases present with the clinical triad of fever, flank pain and limited range of movement of hip, often causing delay in diagnosis. Case Presentation: This case describes atypical and unusual manifestation of psoas abscess when an 80 year old female patient was admitted with suspected bloodstream infection from the GI tract and acute small bowel obstruction. Patient also had non - specific right hip and limb pain, UTIs and episodes of fever over the last two years. On preliminary investigations, no definite cause of intestinal obstruction was found and conservative management proved unsuccessful. A CT scan on the second day of admission confirmed a right psoas abscess and an abrupt transition from dilated to collapsed bowel loops in the right peri - umbilical region, suggesting a dynamic small bowel obstruction. An emergency Laparotomy revealed turbid abdominal fluid and peritonitis and small bowel loops adherent to the right posterior abdominal wall as well as to each other. Bowel loops were inflamed but there were no fistulas or perforation. Adhesionolysis was done, thorough TPL was done, and an ADK drain was placed in the right psoas. Successful treatment of SBO and psoas abscess was achieved through open surgery, the patients condition gradually improved and was discharged with a psoas drain on 13th day post surgery. Conclusion: For patients with Iliopsoas abscess, initial symptoms can be vague and atypical. They can present as functional bowel obstruction and septic shock. Consideration of psoas abscess is warranted if patient has suggestive symptoms like hip pain, limping, fever. Because of its atypial presentation, early diagnosis through imaging can significantly improve the prognosis.