A challenging case of bilateral iliopsoas abscess.

Background: Bilateral iliopsoas abscess is very rare and has never been reported in cases of aortic graft infections. To date, only cases of unilateral abscess have been reported in association with aortic graft infection, and even these are uncommon.

Methods: Case report and literature review.

Results: We present the first report of an infected abdominal aortic graft, secondary to an ileal perforation, in a 76-year-old woman presenting with bilateral iliopsoas abscess. The presence of lumbar spondylodiscitis initially led us to suspect this as the primary cause of the abscess. Hence, she was treated initially with drainage of the abscess, percutaneously and surgically. This proved to be unsuccessful. A laparotomy, excision of the aortic graft, and in situ revascularization with a femoral venous conduit was performed subsequently. The bilateral iliopsoas abscess was found to be caused by a perforation of the ileum. Despite the surgery, the patient finally succumbed.

Conclusions: Bilateral iliopsoas abscess secondary to infected aortic graft is extremely rare and challenging. Drainage of the abscess, percutaneously or surgically, and excision of graft with or without revascularization must be considered carefully based on the individual case.