What Is an Intra-abdominal Abscess?

Abdominal abscess refers to a gap or part of the abdominal cavity that is liquefied due to tissue necrosis and is wrapped by intestinal curvature, internal organs, abdominal wall, omentum or mesentery, forming a limited accumulation of pus. These include sub-diarrheal abscesses, pelvic abscesses, and intestinal abscesses. Various diseases that cause secondary peritonitis can cause this disease after abdominal surgery and trauma.

Basic Information

English name

peritoneal abscess

Visiting department

surgical

Common locations

Abdominal cavity

Common causes

infection

Common symptoms

Abdominal pain and persistent dull pain are released to the shoulder and back. When the abscess is enlarged, there may be pain, shortness of breath, cough or snoring; intermittent or relaxation type high fever, etc.

Causes of abdominal abscess

Infection is the main cause of abdominal abscess.

Clinical manifestations of abdominal abscess

Subcondylar abscess

(1) Toxemia Early manifestations of bacterial toxemia, that is, intermittent or relaxation-type high fever suddenly occurred during the rehabilitation process, sometimes chills, high fever, loss of appetite, fast or weak pulse rate, weakness and even blood pressure drop.

(2) Pain : Abdominal pain, aggravation during deep breathing and turning position, persistent dull pain released to the shoulder and back, and swelling, shortness of breath, cough or snoring when the abscess is enlarged.

(3) There are throbbing pain and tenderness in the sub-condylar and quarter-costal areas. If the abscess is superficial, the skin has concave edema.

(4) The respiratory movement on the affected side becomes smaller, and the intercostal space is not as obvious as on the healthy side.

(5) Liver dullness is elevated.

(6) Gas is contained in the pus cavity in about 25% of the cases. Four different acoustic zones can be knocked out. The lower layer is dullness of the liver or dullness of the pus. The upper layer is the drum sound of the gas. Or dullness of the atrophic lung, the uppermost layer is the unvoiced sound of the lung.

(7) The breathing sound at the base of the affected side weakens or disappears.

(8) Leukocyte count increased and the proportion of neutrophils increased.

2. Pelvic abscess

Pelvic abscesses have mild systemic symptoms and relatively local symptoms. During the peritonitis, or after pelvic surgery, the relaxation and fever did not regress, or it increased after descending, and rectal and bladder irritation appeared. Manifestations include discomfort in the lower abdomen, heavy after anxiety, frequent stools, and stool with mucus; frequent urination, urgency, and even difficulty urinating. Digital rectal examination can reveal anal sphincter relaxation, anterior rectal wall swelling, and tenderness.

3. Intestinal abscess

After peritonitis, the pus is surrounded by the intestines, mesentery, and omentum, and can form single or multiple abscesses of various sizes. Presented with low fever and abdominal pain. Larger abscesses can be painful and can be accompanied by symptoms of systemic poisoning.

Abdominal abscess examination

1. X-ray inspection

The patient took an upright position and filmed from the front, back, and side positions. The transverse diaphragm movement on the diseased side disappeared or weakened, indicating a subcondylar infection, but not necessarily pus. It can also be found that the diseased side of the diaphragm is elevated and the costosacral angle disappears, and the lung field is blurred, indicating a reactive pleural effusion or a change in lung protrusion. You can see a gas-liquid surface beneath the diaphragm, and perforation of the stomach and duodenum Gas, left subcondylar abscess showed gastric compression displacement.

2.B-ultrasound

B-ultrasound can clearly show the size, location, and depth of the pus cavity. It can also perform puncture and pus under the guidance of B-ultrasound, or mark the puncture point on the body surface for diagnostic puncture.

3.CT

Feasible qualitative localization diagnosis.

4. Diagnostic puncture

Can be punctured under the guidance of X-ray or B ultrasound, if the pus is extracted, the incision is drained immediately.

Abdominal Abscess Treatment

1. Treatment of sub-condylar abscess

In the treatment of peritonitis, the patient is placed in a semi-recumbent position, and antibiotics are selected reasonably. Careful hemostasis and placement of a drainage tube after gastrectomy can effectively prevent the formation of sub-diarrheal abscesses. Even in the early stages of the formation of sub-diarrheal abscesses, inflammation may subside through antibiotics and supportive therapies. However, after a few weeks of treatment, the fever persists and the patient's physical exertion is large, it is still appropriate to drain in time. Puncture drainage under B-ultrasounding is a simple and effective treatment for deeper abscesses with smaller locations, smaller pus cavities and thin pus. Surgical drainage is still recommended for those with large pus cavities, thick pus walls, or multifamily sex.

2. Treatment of pelvic abscess

Incision was made through the anterior wall of the rectum or the posterior fornix of the vagina, and a soft silicone tube was placed for drainage. Continue to use antibiotics, hot water bath, perineal physiotherapy and other treatment measures to promote inflammation absorption.

3. Intestinal abscess

Multiple small abscesses can often be absorbed by antibiotics. Large abscesses require laparotomy, which drains the pus, removes the pus wall, and rinses with a large amount of saline or antibiotic solution, usually without drainage.