Effective surgical outcomes of the pararectus approach for psoas abscess: a case series

A psoas abscess is a rare but potentially life-threatening condition that requires timely diagnosis and management. Surgical intervention is essential in patients with percutaneous drainage failure, multiloculated abscesses, or implant-related pathologies. This case series highlights the use of the pararectus approach, originally developed for acetabular fractures, to manage complex retroperitoneal infections. Two cases are presented: a metastatic breast cancer patient with a left psoas abscess extending to the hip joint and a patient with a history of pelvic and spinal instrumentation presenting with bilateral iliopsoas abscesses. Both patients underwent successful surgical debridement using the pararectus approach, demonstrating its efficacy in accessing and draining retroperitoneal abscesses, with minimal complications. This approach provides an effective visualization of critical structures, enabling comprehensive treatment while minimizing tissue damage. These findings underscore the utility of the pararectus approach for managing challenging psoas abscesses, ensuring rapid drainage and bacterial culture acquisition for targeted antimicrobial therapy.