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 Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.