An abdominal abscess is a localized collection of pus that forms within the abdominal cavity. This pocket of infection can develop in various locations, affecting organs or spaces. Untreated, this can lead to serious health issues.
Understanding Abdominal Abscesses
An abdominal abscess forms when the body’s immune system walls off an infection or inflammation. Bacteria enter the abdominal cavity due to injury, surgery, or underlying conditions, forming a pocket of pus and cellular debris.
Bacterial infections are the most frequent cause. Conditions like appendicitis, diverticulitis, or inflammatory bowel disease can lead to inflammation, causing abscesses. Abdominal surgery or trauma, like gunshot or stab wounds, can also introduce bacteria, promoting abscess development.
Location categorizes abscesses. Intra-abdominal abscesses occur within the peritoneal cavity (e.g., intestines, stomach, liver). They are visceral (e.g., liver, spleen, pancreas) or non-visceral (e.g., pelvis, subdiaphragmatic). Retroperitoneal abscesses develop behind the peritoneum, often involving organs like the kidneys or pancreas.
Recognizing the Signs
Symptoms vary by size and location. Persistent, severe abdominal pain is common. Pain may localize to the upper abdomen, lower back, shoulder, or chest.
Systemic infection indicators include fever and chills. Malaise and fatigue are common. Digestive symptoms include nausea, vomiting, loss of appetite, sometimes leading to weight loss.
Changes in bowel habits, like diarrhea or rectal tenderness, can occur. If the abscess affects surrounding structures, symptoms like cough, painful breathing, or chest pain may be present. Prompt medical evaluation is necessary.
Diagnosis and Treatment Approaches
Diagnosis begins with a physical examination and symptom review. Providers check for abdominal tenderness and may identify a palpable mass. Blood tests, like a complete blood count (CBC), detect infection signs, such as an elevated white blood cell count.
Imaging tests confirm abscess presence and location. CT scans of the abdomen and pelvis are the most common and effective tool, detailing size and relationship to surrounding organs. Ultrasound or MRI may also be used. Sometimes, a fluid sample from the abscess identifies specific bacteria, guiding antibiotic selection.
Treatment involves drainage and antibiotic therapy. Drainage is primary, as antibiotics alone may not penetrate the walled-off cavity. Percutaneous drainage (PAD) is a common minimally invasive procedure using imaging guidance (CT or ultrasound) to insert a needle and catheter into the abscess. Pus drains into an external bag; the catheter remains until drainage is complete.
If percutaneous drainage is not feasible or effective, surgical drainage may be necessary. During surgery, the abscess is cleaned out, and a drain may be placed. Broad-spectrum antibiotics combat the infection. Antibiotic regimen may be adjusted once culture results are available, targeting identified microorganisms. This combined approach eliminates infection, reduces symptoms, and prevents complications.
Potential Complications
Untreated or delayed treatment can lead to severe complications. Sepsis is a severe condition where infection spreads into the bloodstream, triggering a widespread inflammatory response. It can result in organ dysfunction and, if not managed promptly, can be fatal.
Abscess rupture is another risk. If the pus breaks open, infection spreads, leading to severe peritonitis. This causes widespread infection and organ damage. Infection can also extend to adjacent organs, forming new abscesses or fistulas (abnormal connections).
Delayed treatment can lead to chronic inflammation, forming adhesions or scar tissue, complicating future surgical interventions. Prompt medical attention and adherence to treatment avoid these severe outcomes and ensure successful recovery.