What Are Intra-abdominal Abscesses?

Intraabdominal abscesses form mainly after surgery, trauma or illnesses that cause infection or swelling. Read more about them in this article.
What are intra-abdominal abscesses?

Intraabdominal abscesses are collections of pus located inside the abdominal cavity. They can be located anywhere in the abdomen. They are formed mainly after surgery, trauma or diseases that cause infection or swelling in the stomach, especially peritonitis.

Causes of intra-abdominal abscesses

Person has abdominal pain due to intra-abdominal abscesses

Some of the causes of intra-abdominal abscesses are:

  • Infections caused by inflammation of organs such as the gallbladder or appendix or gastrointestinal perforation.
  • Severe abdominal trauma.
  • Postoperative abdominal surgery infections.

Symptoms

The most common symptoms of intra-abdominal abscesses are general malaise, fever and abdominal pain. Sometimes when a doctor performs a physical examination, they may feel lumps in the stomach.

Intraabdominal abscesses may form within one week after gastrointestinal perforation or peritonitis. However, postoperative abscesses do not appear until two to three weeks after surgery, and in rare cases only several months later.

Also read: Inguinal hernia: Cause and treatment

Although symptoms vary, most abscesses cause fever and abdominal pain. The symptoms can be mild or severe. Nausea, refusal to eat and weight loss are quite common. However, other abscesses, such as a recto-uterine sac, can cause diarrhea.

If it is close to the bladder, it can also cause urgent urination. Subphrenic abscesses can also cause symptoms in the chest such as dry cough, chest pain and dyspnoea (shortness of breath). Usually there is tenderness where the abscess is located. Large abscesses can feel like lumps.

Types of intra-abdominal abscesses

Intraabdominal abscesses are classified as intraperitoneal, retroperitoneal or visceral. Many intra-abdominal abscesses manifest after gastrointestinal perforation or colon cancer.

Others are formed due to the spread of an infection or secondary inflammation to conditions such as appendicitis, diverticulitis, Crohn’s disease, pancreatitis (inflammation of the pancreas), pelvic inflammatory disease or any condition that causes generalized peritonitis.

Abdominal surgery, especially those that affect the digestive system, is another significant risk factor. The peritoneum can become infected during or after surgery.

Untrained intra-abdominal abscesses can damage adjacent structures and vessels, which can lead to bleeding or thrombosis. They can also penetrate the intestine or peritoneum and even form a cutaneous or urogenital fistula. However, a low abdominal abscess can go down to the thigh.

Diagnosis

Medical professionals typically resort to computed tomography (CT scan) for diagnosis. This technique also allows them to choose the best way to drain and treat the infection.

Magnetic resonance imaging (MR) is another highly accurate imaging test performed in some situations. There are other simpler tests such as abdominal ultrasound. However, the quality of the images is not as good as an MRI scan.

Also read: Constant stomach pain: Your body is trying to tell you something

Treatment

Person with stomach pain

Treatment involves antibiotics and percutaneous or surgical drainage. Almost all intra-abdominal abscesses require drainage, either through surgery or percutaneous catheters.

Medical professionals can drain the abscess through the skin by percutaneous drainage, guided by imaging techniques such as ultrasound. In some severe cases, surgical drainage, which requires surgery in an operating room, may be necessary.

Drainage through catheters may be appropriate when the abscess cavities are large and the drainage path does not pass through uncontaminated organs. In addition, it is convenient to resort to drainage through catheters when the origin of the infection is checked and pus is fluid enough to flow through the catheter.

Meanwhile, antibiotics can limit the spread of infection through the bloodstream and should be administered before and after the intervention. Treatment often requires drugs that promote the healing of the intestinal flora, such as gentamicin and metronidazole.

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