Abscess of the piriformis muscle in a 14-year old boy - a transrectal drainage method under transabdominal ultrasound guidance
More details
Hide details
Department of Surgery, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Clinical Ward of Paediatric Surgery and Urology, Regional Specialist Children's Hospital in Olsztyn, Poland
Submission date: 2022-02-16
Final revision date: 2022-09-23
Acceptance date: 2022-09-23
Online publication date: 2022-10-28
Corresponding author
Katarzyna Anna Szymak   

Clinical Ward of Paediatric Surgery and Urology, Regional Specialist Children's Hospital in Olsztyn, Żołnierska 18a, 10-561 Olsztyn, Poland.
Pol. Ann. Med. 2022;29(2):244-248
Sciatica is a common reason for a medical consultation throughout the population. Piriformis pyomyositis is a rare cause of these symptoms. Its probable etiology is transient bacteraemia co-existing temporarily with a muscle injury.

The aim of the study is to present a method for treating a piriformis muscle abscess with transabdominal ultrasound-guided transrectal drainage.

Case study:
A 14-year old boy, previously healthy, was admitted with symptoms of sciatica that appeared after intense physical exertion. Laboratory tests revealed elevated inflammatory parameters and positive blood culture results indicating Staphylococcus aureus. Antibiotic therapy was implemented. MRI of the small pelvis revealed a forming abscess of the right piriformis muscle. On day 6 of the antibiotic therapy, in the absence of improvement, it was decided to perform transrectal drainage under ultrasound guidance. Clinical improvement was achieved, and the inflammatory parameters decreased.

Results and discussion:
Co-existence of sciatica symptoms and signs of an inflammatory condition should prompt the consideration of piriformis pyomyositis. The mainstay of treatment for piriformis pyomyositis is antibiotic therapy. The abscess formation reduces its effectiveness, which necessitates surgical intervention. The authors present the application of transrectal drainage under transabdominal ultrasound guidance as the shortest route of abscess evacuation.

Transrectal drainage of piriformis pyomyositis is an effective and safe method. Concomitant use of ultrasound scans reduces the patient’s exposure to ionising radiation. However, the widespread use of this method requires more in-depth research and broadened experience.

We acknowledge Natalia Hawryluk, Paediatric Surgery Students’ Association, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, for her editional work, Biuro Tłumaczeń OSCAR for translation. Special acknowledgments for Stowarzyszenie na rzecz Dzieci Leczonych Chirurgicznie ‘Uśmiech’ for supporting pediatric surgeons in their scientific work.
None declared.
None declared.
Elhagar A, Kamar I, Elsheikh MFH, et al. Unusual case of lower back pain-piriformis myositis: a case report and literature review. Pan Afr Med J. 2019;32:4. https://doi:10.11604/pamj.2019....
Probst D, Stout A, Hunt D. Piriformis syndrome: A narrative review of the anatomy, diagnosis, and treatment. PM R. 2019;11(Suppl 1):S54–S63. https://doi:10.1002/pmrj.12189.
Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74(2):69–72. https://doi:10.1080/00325481.1....
Siddiq MAB, Rasker JJ. Piriformis pyomyositis, a cause of piriformis syndrome-a systematic search and review. Clin Rheumatol. 2019;38(7):1811–1821. https://doi:10.1007/s10067-019....
Ou Yang Y, Lo DYK, Lo DYK, Ke Y, Lee DYH. Piriformis Pyomyositis Presenting as Migratory Hip to Knee Pain. JBJS Case Connect. 2020;10(4):e20.00251. https://doi:10.2106/
Marchel H, Wróblewska M. Bloodstream infections– etiology and current microbiological diagnostics. Pol Ann Med. [in press].
Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain. 2020;33(4):305–317. https://doi:10.3344/kjp.2020.3....
Barros AAG, Soares CBG, Temponi EF, Barbosa VAK, Teixeira LEM, Grammatopoulos G. Piriformis Pyomyositis in a Patient with Kikuchi-Fujimoto Disease – A Case Report and Literature Review. Rev Bras Ortop (Sao Paulo). 2019;54(2):214–218. https://doi:10.1016/j.rboe.201....
Miller NJ, Duncan RD, Huntley JS. The conservative management of primary pyomyositis abscess in children: case series and review of the literature. Scott Med J. 2011;56(3):i–181. https://doi:10.1258/smj.2011.0....
Wong LF, Mullers S, McGuinness E, Meaney J, O’Connell MP, Fitzpatrick C. Piriformis pyomyositis, an unusual presentation of leg pain post partum – case report and review of literature. J Matern Fetal Neonatal Med. 2012;25(8):1505–1507. https://doi:10.3109/14767058.2....
Toda T, Koda M, Rokkaku T, et al. Sciatica caused by pyomyositis of the piriformis muscle in a pediatric patient. Orthopedics. 2013;36(2):e257-e259. https://doi:10.3928/01477447-2....
Hryniewicz W, Ozorowski T, Deptuła A. Protocol of the proceedings with the patient with whom bacteremia was found on the etiology of Staphylococcus aureus [in Polish]. Warszawa: Narodowy Instytut Leków; 2018., Accessed: October 28, 2022.
Colmegna I, Justiniano M, Espinoza LR, Gimenez CR. Piriformis pyomyositis with sciatica: an unrecognized complication of "unsafe" abortions. J Clin Rheumatol. 2007;13(2):87–88. https://doi:10.1097/01.rhu.000....
Koda M, Mannoji C, Watanabe H, et al. Sciatica caused by pyomyositis of the piriformis muscle. Neurol India. 2013;61(6):668-669. https://doi:10.4103/0028-3886.....
Khoury A, Mosheiff R, Nassrallah K, Khoury A. Combined approach for intrapelvic abscess drainage among adults. Trauma Case Rep. 2020;31:100383. https://doi:10.1016/j.tcr.2020....
McDaniel JD, Warren MT, Pence JC, Ey EH. Ultrasound-guided transrectal drainage of deep pelvic abscesses in children: a modified and simplified technique. Pediatr Radiol. 2015;45(3):435-438. https://doi:10.1007/s00247-014....
Potet J, Franchi-Abella S, Al Issa M, Fayard C, Pariente D. Drainage par voie transrectale sous contrôle échographique sus-pubien des abcès du douglas chez l’enfant: Technique et résultats. J Radiol. 2010;91(2):221–225. https://doi:10.1016/S0221-0363....
Journals System - logo
Scroll to top