Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Fever and chills• Tachycardia• Leukocytosis• Focal abdominal tenderness• Predisposing condition +++ Epidemiology + • Most common causes are-GI perforations-Postoperative complications-Penetrating trauma-Genitourinary infections• 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: -Subdiaphramatic-Subhepatic-Pericolic-Pelvic-Interloop abscesses +++ Symptoms and Signs + • Fever and chills• Tachycardia• Focal abdominal tenderness• Prolonged ileus or sluggish postoperative recovery• Mass seldom appreciated• Irritation of contiguous structures manifesting symptoms such as:-Lower chest pain-Dyspnea-Referred shoulder pain or hiccup-Basilar atelectasis or effusion-Diarrhea-Urinary frequency• Severe peritoneal sepsis with multiple organ failure may develop in patients with advanced cases +++ Laboratory Findings + • Leukocytosis• Bacteremia• Abnormal liver profile, renal function tests, or ABG measurements• Elevated ESR and C-reactive protein levels +++ Imaging Findings + • Abdominal x-ray: Suggest abscess in up to 50% of cases via nonspecific findings, such as -Ileus pattern-Air-fluid levels-Soft-tissue mass-Free or mottled gas pockets-Effacement of preperitoneal or psoas outlines-Displacement of viscera• US-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-Percutaneous drainage procedures can often be performed at the same setting + • Sterile fluid collection• Hematoma• Biloma• Urinoma• Neoplasm• Other common infectious/inflammatory sources that manifest with fever, leukocytosis, and abdominal pain: -Pancreatitis-Pyelonephritis-Lower lobe pneumonia-Deep wound infection• Bacteremia/line sepsis• Evaluate for source of abscess:-GI anastomotic leak-Perforated appendicitis-Perforated diverticulitis-Crohns enterocolitis-Perforated peptic ulcer-Pelvic inflammatory disease/tubo-ovarian abscess + • CBC• Basic chemistries• Amylase and lipase• UA• Blood cultures• Sputum culture and Gram stain• Chest film• Abdominal x-ray• Abdominal pelvic CT scan with IV and PO contrast +++ When to Admit + • All patients with an intra-abdominal abscess should be admitted (if not already) for drainage and initiation of IV antibiotics +++ When to Refer + • Most patients with intra-abdominal abscesses should be managed by a general surgeon• Postoperative abscesses ideally should be addressed by the operative surgeon + • 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 ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth