Table of Contents
Page created on October 11, 2021. Last updated on December 18, 2024 at 16:58
Definition and epidemiology
Intraabdominal (or intraperitoneal) abscesses are serious conditions which usually develop secondary to a pre-existing or concomitant abdominal infection. It can involve any abdominal organ, be located between bowel loops, or be free within the cavity. They may lead to organ failure, sepsis, shock, and death, and as such have a high mortality rate of 10 – 40%.
Etiology
- Abdominal surgery
- Perforated hollow organ (appendicitis, peptic ulcer)
- Crohn disease
- Diverticulitis
- Ischaemic bowel disease
- Pancreatic necrosis
- Gangrenous cholecystitis
- Abdominal trauma
Classification
- Intraperitoneal abscess
- Subphrenic abscess
- Interloop abscess
- Paracolic abscess
- Pelvic abscess
- Retroperitoneal abscess
- Pancreatic abscess
- Perinephric abscess
- Visceral abscess
- Hepatic abscess
- Splenic abscess
Clinical features
Intraabdominal abscess commonly presents with abdominal pain (usually corresponding to the area of the abscess) and fever. The mass may be palpable. There may be symptoms of the infection source. There’s often a history of surgery, trauma, or known intra-abdominal infection. Subphrenic abscesses may cause chest symptoms or shoulder pain.
Untreated abscess may rupture, form fistulae, or erode into vessels, potentially causing sepsis or haemorrhage.
Diagnosis and evaluation
Labs will show elevated infectious parameters. Blood cultures are often negative. Oral contrast CT is the modality of choice, as it’s the best modality to show the abscess and its borders.
Treatment
Treatment is, as for most abscesses, IV antibiotic therapy and drainage. Drainage may be percutaneous or surgical. Abscesses located in the pelvis may be drained transrectally or transvaginally. Patients should also receive supportive therapy with fluids.