Intra-abdominal abscesses: what are they?

Intra-abdominal abscesses are pus accumulations located inside the abdominal cavity. They can be located anywhere in the abdomen.

They are formed mainly after surgery, trauma or diseases which involve infection or abdominal inflammation, in particular, when peritonitis or perforation occurs.

Causes of intra-abdominal abscesses

Some of the causes of intra-abdominal abscesses are the following:

• Infections produced by the organ inflammation such as the gallbladder or the appendix, or perforation of the small or large intestine.
• Severe abdominal trauma.
• Infections that appear in the postoperative abdominal surgery.

symptom

The symptoms more frequent of intra-abdominal abscesses are malaise, fever and abdominal pain. Sometimes, when performing the physical examination, you can feel masses in the abdomen.

Intra-abdominal abscesses they can be formed within 1 week of perforation or peritonitis. However, postoperative abscesses may not appear until 2-3 weeks after surgery and, rarely, up to several months later.

Although the symptoms are variable, Most abscesses present with fever and abdominal pain. Symptoms can be mild or intense, with nausea, anorexia and weight loss frequent.

However, other types of abscesses, such as those of the Douglas pouch, can cause diarrhea. Further, the closeness to the bladder can cause urgent urination and frequency.

Also subphrenic abscesses can cause chest symptoms, such as non-productive cough, chest pain and dyspnea. Usually, there is pain on palpation over the abscess site. Large abscesses can be palpated as a mass.

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Types of intra-abdominal abscesses

Intra-abdominal abscesses They are classified as intraperitoneal, retroperitoneal or visceral. Many intra-abdominal abscesses appear after perforation of a viscera or colon cancer.

Others are formed by extension of infection or inflammation secondary to symptoms such as appendicitis, diverticulitis, Crohn's disease, pancreatitis, pelvic inflammatory disease or any disorder that causes generalized peritonitis.

Abdominal surgery, in particular that which affects the digestive system, is another significant risk factor. The peritoneum can become contaminated during or after surgery.

Undrained intra-abdominal abscesses can cause damage to adjacent structures and vessels, which can lead to bleeding or thrombosis.

They can also rupture into the intestine or peritoneum and even form a cutaneous or genitourinary fistula. However, a lower abdominal abscess may descend to the thigh.

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Diagnosis

The diagnosis is carried out by performing a computerized axial tomography. This technique also allows selecting the best way to drain and treat the infection.

Magnetic resonance imaging is another highly accurate imaging test performed in some situations. However, there are other simpler tests, such as abdominal ultrasound, although the quality of the images is not as good as that of the other tests.

Which is the treatment?

The treatment includes the use of antibiotics and percutaneous or surgical drainage. Almost all intra-abdominal abscesses require drainage, either by percutaneous catheters or surgery.

Drainage through catheters may be appropriate when the cavities in the abscess are large and When the drainage route does not cross the intestine, organs, pleura or peritoneum not contaminated.

In addition, the use of drainage is appropriate when the origin of the infection is controlled and the pus is liquid enough to circulate through the catheter.

Antibiotics can limit the spread of infection by blood and should be administered before and after the intervention. The treatment requires active drugs against the intestinal flora, such as gentamicin and metronidazole.

In summary, the treatment of intra-abdominal abscesses consists of drainage of purulent contents, accompanied by the administration of antibiotics.

Drainage is carried out through the skin, through percutaneous drainage, and can be guided by imaging tests such as ultrasound. In some cases of greater severity, a surgical drainage may be necessary, that requires an operation in the operating room.