• Most common causes are
• Abscess forms as sequelae of generalized peritonitis in 33% of cases
• Intra-abdominal abscess forms adjacent to diseased viscus (eg, perforated appendicitis) or as a result of external contamination (subphrenic abscess)
• Broadly classified based on anatomic location:
• Fever and chills
• Focal abdominal tenderness
• Prolonged ileus or sluggish postoperative recovery
• Mass seldom appreciated
• Irritation of contiguous structures manifesting symptoms such as:
• Severe peritoneal sepsis with multiple organ failure may develop in patients with advanced cases
• Abnormal liver profile, renal function tests, or ABG measurements
• Elevated ESR and C-reactive protein levels
• Abdominal x-ray: Suggest abscess in up to 50% of cases via nonspecific findings, such as
-Diagnose intra-abdominal abscesses in up to 80% of cases
-Most useful when an abscess is suspected in the right upper quadrant
-Bowel gas, stomas, and incisions interfere with the study
• Water-soluble contrast study sensitive in detecting a perforated viscus
• Abdominal pelvic CT scan with IV and PO contrast is the best diagnostic study with > 95% sensitivity, particularly in postoperative patients
• Sterile fluid collection
• Other common infectious/inflammatory sources that manifest with fever, leukocytosis, and abdominal pain:
-Lower lobe pneumonia
-Deep wound infection
• Bacteremia/line sepsis
• Evaluate for source of abscess:
• IV antibiotic therapy may initially be attempted for small abscesses < 1-2 cm if the patient is clinically stable
• Treatment of most abscesses consists of prompt and complete drainage, control of the primary cause, and adjunctive use of antibiotics
• Percutaneous drainage is the preferred ...
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