Related Subjects:Acute Cholecystitis
|Acute Appendicitis
|Chronic Peritonitis
|Abdominal Aortic Aneurysm
|Ectopic Pregnancy
|Acute Cholangitis
|Acute Abdominal Pain/Peritonitis
|Assessing Abdominal Pain
|Penetrating Abdominal Trauma
|Acute Pancreatitis
|Acute Diverticulitis
About
- A cause of fever which may be unexplained
- Consider in those post op with fever
Aetiology
- Due to peritonitis
- Due to intraabdominal surgery
Typical Sites
- Subphrenic, Subhepatic, Pelvis
- Between loops of bowel
Pathology
- Can rupture locally, Blood spread of infection
- Erosion into blood vessel with haemorrhage
- Subphrenic rupture into pleural cavity or cause a pleural effusion
- Pelvic abscess between uterus and rectum can discharge through rectum
Causes
- Crohn's disease
- Diverticular disease
- Cholangitis/Cholecystitis
- Acute Appendicitis
- Pancreatitis
- Pelvic inflammatory disease
- Post abdominal surgery.
Clinical
- Pyrexia, Tachycardia, PUO
- Abdominal pain or discomfort
- Anorexia, weight loss
- Pelvic abscess - diarrhoea and boggy swelling on PR
Microbiology
- Aerobic gram-negative bacilli (eg, Escherichia coli and Klebsiella)
- Anaerobes (especially Bacteroides fragilis)
Investigations
- FBC: elevated WCC. CRP: elevated. U&E, LFTs, ALP
- CT scan is the imaging modality of choice to determine the presence of an intra-abdominal infection and its source
- USS is the first imaging technique used for suspected acute cholecystitis or cholangitis
- Radionuclide scanning with indium111-labeled leucocytes may be helpful in identifying intra-abdominal abscesses.
- Aspiration is usually diagnostic but may need radiological guidance
- Blood cultures can help identify microbial cause
Poor prognosis
- Delay in the initial intervention
- High severity of illness
- Advanced age
- Comorbidity and degree of organ dysfunctionLow albumin level Poor nutritional status
- Degree of peritoneal involvement or diffuse peritonitis
- Inability to achieve adequate debridement or control of drainage
- Presence of malignancy
Management
- ABC and IV fluids
- Appropriate IV antibiotics as needed
- Surgical pe percutaneous drainage may be needed
- Radiological drainage may be appropriate
- Nutritional support is important
References