Intra-abdominal abscess

Answer 1

Definition

An intra-abdominal abscess is an infected pocket of fluid and pus located inside the belly area (abdominal cavity). There may be more than one abscess.

Alternative Names

Abscess - intra-abdominal

Causes, incidence, and risk factors

An intra-abdominal abscess can be caused by a ruptured appendix, ruptured diverticula, a parasite infection in the intestines (Entamoeba histolytica), or other condition.

Risk factors include a history of appendicitis, diverticulitis, perforated ulcer disease, or any surgery that may have infected the abdominal cavity.

Symptoms

Depending on the location, symptoms may include:

• Abdominal pain and distention
• Chills
• Diarrhea
• Fever
• Lack of appetite
• Nausea
• Rectal tenderness and fullness
• Vomiting
• Weakness

Signs and tests

A complete blood count may show a higher than normal white blood count.

A CT scan of the abdomen will usually reveal an intra-abdominal abscess. After the CT scan is done, a needle may be placed through the skin into the abscess cavity to confirm the diagnosis and treat the abscess.

Other tests may include:

• Abdominal x-ray
• Liver function tests,
• Ultrasound of the belly area

Sometimes surgery called a laparotomy may be needed to diagnose this condition.

Treatment

Treatment of an intra-abdominal abscess requires antibiotics (given by an IV) and drainage. Drainage involves placing a needle through the skin in the abscess, usually under x-ray guidance. The drain is then left in place for days or weeks until the abscess goes away.

Occasionally, abscesses cannot be safely drained this way. In such cases, surgery must be done while the patient is under general anesthesia (unconscious and pain-free). A cut is made in the belly area (abdomen), and the abscess is drained and cleaned. A drain is left in the abscess cavity, and remains in place until the infection goes away.

It is always important to identify and treat the cause of the abscess.

Expectations (prognosis)

The outlook depends on the original cause of the abscess and how bad the infection is. Generally, drainage is successful in treating intra-abdominal abscesses that have not spread.

Complications

Complications include:

• Return of the abscess
• Rupture of an abscess
• Spread of the infection to the bloodstream
• Widespread infection

Calling your health care provider

Call your doctor if you have severe abdominal pain, fevers, nausea, vomiting, or changes in bowel habits.

References

Fry RD, Mahmoud N, Maron J, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap.50.

Marrero F, Qadeer MA, Lashner BA. Severe complications of inflammatory bowel disease. Med Clin North Am.2008;92(3):671-686.

Answer 2

Definition

An intra-abdominal abscess is a pocket of infected fluid and pus located inside the belly (abdominal cavity). There may be more than one abscess.

Alternative Names

Abscess - intra-abdominal

Causes, incidence, and risk factors

An intra-abdominal abscess can be caused by a ruptured appendix, ruptured intestinal diverticulum, inflammatory bowel disease, parasite infection in the intestines (Entamoeba histolytica), or other condition.

Risk factors include a history of appendicitis, diverticulitis, perforated ulcer disease, or any surgery that may have infected the abdominal cavity.

Symptoms

Depending on the location, symptoms may include:

• Abdominal pain and distention
• Chills
• Diarrhea
• Fever
• Lack of appetite
• Nausea
• Rectal tenderness and fullness
• Vomiting
• Weakness

Signs and tests

A complete blood count may show a higher than normal white blood count. A comprehensive metabolic panel may show liver, kidney, or blood chemistry problems.

A CT scan of the abdomen will usually reveal an intra-abdominal abscess. After the CT scan is done, a needle may be placed through the skin into the abscess cavity to confirm the diagnosis and treat the abscess.

Other tests may include:

• Abdominal x-ray
• Ultrasound of the abdomen

Sometimes surgery called a laparotomy may be needed to diagnose this condition.

Treatment

Treatment of an intra-abdominal abscess requires antibiotics (given by an IV) and drainage. Drainage involves placing a needle through the skin in the abscess, usually under x-ray guidance. The drain is then left in place for days or weeks until the abscess goes away.

Occasionally, abscesses cannot be safely drained this way. In such cases, surgery must be done while the patient is under general anesthesia (unconscious and pain-free). A cut is made in the belly area (abdomen), and the abscess is drained and cleaned. A drain is left in the abscess cavity, and remains in place until the infection goes away.

It is always important to identify and treat the cause of the abscess.

Expectations (prognosis)

The outlook depends on the original cause of the abscess and how bad the infection is. Generally, drainage is successful in treating intra-abdominal abscesses that have not spread.

Complications

Complications include:

• Return of the abscess
• Rupture of an abscess
• Spread of the infection to the bloodstream
• Widespread infection in the abdomen

Calling your health care provider

Call your doctor if you have severe abdominal pain, fevers, nausea, vomiting, or changes in bowel habits.

References

Fry RD, Mahmoud N, Maron J, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap.50.

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 145.

Reviewed By

Review Date: 07/07/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.