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
- 🦠 Intra-abdominal abscess is a potential cause of unexplained fever, particularly in post-operative patients.
- ⚠️ Should always be considered in patients with persistent fever after abdominal surgery.
🔎 Aetiology
- Often arises as a complication of peritonitis.
- Frequently associated with recent intra-abdominal surgery or severe infection.
📍 Typical Sites
- Subphrenic (below diaphragm), subhepatic (beneath liver), and pelvic regions.
- May also form between bowel loops.
🧬 Pathology
- Abscesses may rupture locally, spreading infection via tissues or bloodstream.
- Can erode into blood vessels, leading to haemorrhage.
- Subphrenic abscesses may rupture into the pleural cavity → pleural effusion.
- Pelvic abscesses (e.g., pouch of Douglas) may discharge into the rectum.
⚡ Causes
- 🔥 Crohn’s disease or diverticular disease.
- 🫀 Cholangitis or cholecystitis.
- 🩺 Acute appendicitis, pancreatitis.
- ❤️🔥 Pelvic inflammatory disease (PID).
- 🔪 Post-abdominal surgery complications.
🩺 Clinical Features
- 🌡️ Fever and tachycardia (often PUO presentation).
- ⚡ Abdominal pain or diffuse discomfort.
- ⬇️ Anorexia and weight loss.
- 💩 Pelvic abscesses → diarrhoea, boggy swelling on rectal exam.
🧫 Microbiology
- Gram-negative bacilli: E. coli, Klebsiella.
- Anaerobes: especially Bacteroides fragilis.
🔬 Investigations
- 🧾 Bloods: ↑ WCC, ↑ CRP, U&E, LFTs, ALP.
- 🖥️ CT abdomen: gold standard for diagnosis and locating abscess.
- 🩻 Ultrasound: useful in acute cholecystitis/cholangitis.
- ☢️ Radionuclide (Indium-111 WBC scan) → localises occult abscesses.
- 💉 Aspiration (with radiology guidance).
- 🧫 Blood cultures: help identify causative organism.
🚨 Poor Prognosis Indicators
- ⏳ Delayed intervention.
- Severe illness at presentation.
- 👴 Advanced age, frailty, comorbidities.
- Organ dysfunction, low albumin, malnutrition.
- Diffuse peritonitis or extensive involvement.
- Failure of adequate surgical/radiological drainage.
- Underlying malignancy.
💊 Management
- 🛑 ABCs: stabilise airway, breathing, circulation. Give IV fluids.
- 💉 Broad-spectrum IV antibiotics (adjust once cultures available).
- 🪡 Percutaneous or surgical drainage of abscess.
- 📸 Radiological drainage in selected patients.
- 🥗 Optimise nutrition for recovery.
