Intraabdominal abscess

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 dysfunction Low 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