Concerning about medical check at hospital during the pandemic, a elderly female went for treatment at a private clinic had severe complications

12/08/2021 16:22

July, 2021, Viet Duc University Hospital took in and treated a female patient 71 years old for lumbar muscle abscess after injected painkiller at a private clinic. Fortunately, as the patient was actively treated that the disease is remission and did not affect her health as well as her spinal function.

 

That is a female patient 71 ages, N.T.P lives in Hong Nam, Hung Yen. Coming for emergency on 14^th July, she was having back pain especially right side, hard to walk without relative assisted. The muscle of right waist area from lumbar vertebrae L4 all the way to sacrum S2 was tense and painful, difficult in stretching her right leg. MRI result shows located pelvic muscle from lumbar vertebrae to sacrum has many heterogeneous liquid collections, biggest one is 57x13x16mm. She was suspected the multiple abscess descending in right lumber muscles after injection.

 

Sharing with doctor, patient said due to her long-term illness that caused backache, she went to hospital for checkup and scanning, doctors said she have spinal degeneration of L5-S2 disc, does not affect significantly spinal cord, just need to use medicines, workout following the instruction shall be fine. However, the illness will soon be chronic and must have frequent checkup, consultation in order to adjust medicines and adequate workout, especially when patient is an elderly.  

 

Recently due to the widespreading Covid-19 pandemic effection so patient was worried of high-risk infection from coming to hospital for examination as it has to interact with many people, therefore she came to a nearby private clinic for examination. Doctor had injected a few times into right back area. This time after injection 3 days, the pain increased, fever, difficulty in walking so family decided to take her to upper level. Patient mentioned about going to prive clinice for examination and injection a few times, however, she does not know what kind of medicine and the doctor only explained it as medicine for treatment. First few times it reduced the pain so the patient was still coming to this place.

 

 

Admitting to Viet Duc University Hospital, she received treatment at Septic Surgery and Wound Care Department with antibiotic, painkiller and immobility in-bed. After a week of positive treatment process, less pain, reduced fever, patient is able to stretch her leg normally. It was expected to drain the pus under ultrasound guide.

 

 

 Ass. Prof. Nguyen Duc Chinh – MD, PhD, former Head of Septic Surgery and Wound Care Department informed: lumbar pelvic muscle (psoas muscle in medical term) is the muscle from lumbar down to pelvic and thigh. Psoas inflammation, usually forms abscess. Psoas abscess is a condition in which the inflammation is thicken and pus on this muscle when there is an intrusion from bacteria, might occur one or both sides. The disease is normally the secondary to sepsis (usually from people with immunodeficiency), more common compares to sepsis from close organs. Bacteria is commonly intestinal bacteria and staphylococcus takes 1/4 to 1/3 of cases and caused by candidosis is also mentioned, especially in cases of immunodeficiency patients. Additionally, tuberculosis is another common reason that happens casually in Viet Nam. The reason is the tuberculosis spreading from spine and to muscle nearby, form the pus in. Because the disease processes silently and in long period so it can be called as cold abscess (Pott disease, also known as Tuberculous spondylitis). On X-ray examination usually shows clearly image of spine lesions. In case of patient P, it might because of bacteria went through injection puncture and caused disease.

 

Patient with psoas abscess usually has inplace clinical symtomps like unable to stretch leg from the side that has muscle inflammation while crotch join examination shows normal result. If patient doesn’t get in-time treatment then the pus would widespread, even breaks inside the abdomen, extend to inner organs, affects patient’s activities as well as their lives.

 

Treatment for psoas abscess including antibiotic, painkiller and pus draining and immobility. At the present, early treatment, identify location of abscess, pus will mostly be draining under ultrasound. In case of widespread pus, thick or deep locations, high risk of effection to surround organs which required surgical draining.

 

Ass. Prof. Nguyen Duc Chinh – MD, PhD added: it is a fortunate that patient was transfer to Viet Duc University Hospital just in time, the treatment was efficient. Through this case, we recommend the patients and relatives shall visit reliable medical facilities when they have illness for receiving qualified treatment, avoid unexpected complications, people should not worry about Covid-19 infection if they follow with precaution instructions from Ministry of Health. In the meantime, private medical facilities also should compliance the regulation on examination and treatment procedures, especially decontamination and sterile procedures while operating it, to prevent complication like this case.