Intra-abdominal Abscess
last authored: Sept 2009, David LaPierre
Introduction
Intra-abdominal abscess can be a serious complication of gastrointestinal conditions or surgery. Their formation is often indolent, making diagnosis at times difficult.
The Case of...
Causes and Risk Factors
The most common causes include:
- gut perforation, often following peptic ulcer
- perforated appendicitis
- perforated diverticulitis
- gangrenous cholecystitis
- mesenteric ischemia and infarction
- pancreatitis
Other causes include:
- post-operative complications
- penetrating trauma
Organisms commonly include:
- E coli
- Bacteroids fragilis
- Staph and Strep following trauma/surgery
Pathophysiology
Abscesses represent local collections of pus walled off by inflammation, omentum, or viscera.
Signs and Symptoms
- history
- physical exam
History
Presenting symptoms are diverse and include:
- abdominal pain
Subphrenic abscesses can cause:
- shoulder pain
- hiccup
- pulmonary manefestations
Pelvic abscesses can cause:
- polyuria
- diarrhea
- tenesmus
History of abdominal surgery
Physical Exam
Physical exam can reveal
- focal tenderness
- ileus
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
elevated WBC is often present
needle aspiration can be used to perform gram stain and culture
Diagnostic Imaging
Differential Diagnosis
Treatments
Percutaneous drainage is the first line treated, guidied by CT.
Intra-abdominal abscesses can be drained percutaneously.
Iv antibiotics should be given at the same time, emperically and then according to culture results.
Surgical intervention is indicated if drainage fails
Consequences and Course
The Case of...
Additional Resources
Topic Development
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