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Abscess of abdominal cavity

 

Abscess of the abdominal cavity is an inflammation of the abdominal cavity of a purulent character with further melting and the formation of a purulent cavity of various sizes in them with the presence of a pyogenic capsule. It can form in any part of the abdominal cavity with the formation of a number of clinical syndromes: septic, intoxicating, febrile.

Epidemiology

The number of surgical interventions performed on the abdominal organs is constantly growing. This, the use of a huge number of the most diverse antibiotics, as well as a strong weakening of the body's immune system due to rapid urbanization leads to frequent development of postoperative abscesses of the abdominal cavity. According to statistics, postoperative complications in the form of abscess formation develop in 0.8% of patients after scheduled cavitary operations and 1.5% after emergency operations.

Causes of the abdominal abscess

As a rule, abscesses of the abdominal cavity develop after the receipt of various injuries, the transfer of infectious diseases of the gastrointestinal tract, inflammatory processes in organs that are in the abdominal cavity, as well as due to the perforation of the defect in the ulcer of the stomach or duodenum.

Main reasons:

  • Consequence of secondary peritonitis, (perforated appendicitis, failure of anastomoses after cavitary operations, pancreatic necrosis after surgery, traumatic injuries), etc.
  • Inflammations of internal female genital organs of a purulent nature (salpingitis, inflammation of the ovaries, purulent parametrites, pyosalpinks, tubo-ovarian abscesses).
  • Acute pancreatitis and cholecystitis, nonspecific ulcerative colitis.

Osteomyelitis of the spine, spondylitis of tuberculous etiology, inflammation of the perineal tissue.

The main pathogens of the abscesses are aerobic (Escherichia coli, Proteus, Staphylococcus and Streptococcus, etc.) and anaerobic (Clostridium, Bacteroides fragilis, Fusobacteriales) bacterial flora.

Risk factors

Very often abdominal abscesses develop due to surgical interventions on the abdominal organs (most often, after operations on the biliary tract of the pancreas, intestines). There are cases when the peritoneum becomes infected after the intervention, especially if the anastomosis is unsuccessful.

In 70% of cases, the abscess develops in the intraperitoneum or in the retroperitoneal region, in 30% it is localized within an organ.

Pathogenesis

Abscess of the abdominal cavity develops due to hyperreactivity of the immune system with the active growth and reproduction of streptococcal and staphylococcal flora, as well as E. Coli (appendicular abscess). Pathogens penetrate the abdominal cavity with lymphogenous or hematogenous pathways, as well as contact through the fallopian tubes, when a destructive inflammation of organs or organ occurs, injury, perforation, inconsistency of the joints that were applied during the surgical intervention.

The main difference between the abscess of the abdominal cavity is the fact that the focus of inflammation is clearly limited from healthy tissues that surround it. If the pyogenic shell collapses, sepsis and purulent leakage develops. Ulcers can be either single or multiple.

Symptoms of the abdominal abscess

The first signs of abdominal abscesses vary, but in most cases, patients are observed:

  • A sharp fever, chills, which is accompanied by mildly pronounced pulling sensations in the abdominal region, which are amplified by palpation.
  • Frequent urge to urinate (as the abdominal cavity is near the bladder.
  • Constipation.
  • Nausea, which can be accompanied by vomiting.

Also other objective symptoms of abdominal abscess are:

  1. Tachycardia, high blood pressure.
  2. Tension of the muscles of the anterior wall of the abdomen.

If the abscess is subdiaphragmatic, then among the main symptoms are also present:

  1. Painful sensations in the area of hypochondrium, which can intensify during inspiration and irradiate to the scapula.
  2. By changing in the patient's walking, he begins to tilt the torso toward discomfort.
  3. High body temperature.

Complications and consequences

If you do not diagnose the abscess of the abdominal cavity in time and do not start the correct treatment, serious consequences can arise:

  1. Sepsis.
  2. Peritonitis.
  3. Breakthrough pus in the pleural cavity or peritoneum.

That's why, if you feel any discomfort or pain in the abdomen, you should immediately seek help from a gastroenterologist or therapist.

Diagnostics of the abdominal abscess

The main diagnostic methods are:

  1. X-ray of chest and abdominal organs.
  2. Ultrasonography.
  3. CT and MRI as auxiliary diagnostic methods.
  4. Taking a puncture from the posterior vaginal vault or anterior wall of the rectum (if there is a suspicion of developing the abscess of the Douglas zone).

Analyzes

If the abscess can not be diagnosed due to the absence of any symptoms, tests, including a general blood test, can be prescribed. In this disease, the patient is almost always observed leukocytosis, sometimes neutrophilia (a sharp shift of the leukocyte formula to the left), as well as an increase in ESR.

Instrumental diagnostics

With the help of the chest X-ray, you can see that on the affected side the dome of the diaphragm is high. In the pleural zone, you can see a reactive effusion. With a subdiaphragmatic abscess, a gas bubble and a liquid level below it can be seen on X-ray photographs.

Ultrasonic signs of abdominal abscess

The "gold" standard for the diagnosis of abscesses of the abdominal cavity of various locations is ultrasound. Ultrasound signs are: a clearly delineated liquid formation in a capsule whose contents are non-uniform and have the form of a filamentous structure or an echogenic suspension. There is a so-called reverberation effect due to gases, when multiple reflections of sound gradually reduce its intensity.

Treatment of the abdominal abscess

Treatment consists in conducting a surgical operation, the purpose of which is to remove the abscess and drain with a catheter.

Drug treatment does not provide an opportunity to cure abdominal abscess, but with the help of various antibiotics it is possible to limit the spread of infection. That is why doctors prescribe them to patients before and after surgery. Primarily used drugs that can suppress the development of intestinal microflora. In some cases, antibiotics are also recommended that are active against anaerobic bacteria, including Pseudormonas.

Medications

Metronidazole. Effective antimicrobial and antiprotozoal. The drug contains the active substance metronidazole. It is able to reduce the 5-nitro group by intracellular proteins in the simplest and anaerobic bacteria. After the reduction, this nitro group interacts with bacterial DNA, as a result of which the synthesis of nucleic acids of the causative agents is suppressed and they die.

Metronidazole is effective in fighting amoebas, trichomonads, bacteroides, peptococcus, fusobacteria, eubacteria, peptostreptococcus and clostridia.

Metronidazole has a high absorption and effectively penetrates into the affected tissues and organs. Dosage is individual and is established by the attending physician depending on the patient's condition. Patients with metronidazole intolerance, history of epilepsy, diseases of the central and peripheral nervous system, leukopenia, abnormal liver function, use of the drug is prohibited. Also, you can not prescribe during pregnancy.

In some cases, the use of the drug can cause: vomiting, anorexia, diarrhea, glossitis, pancreatitis, migraines, vertigo, depression, allergy, dysuria, polyuria, candidiasis, frequent urination, leukopenia.

Prevention

Preventive measures are based on adequate and timely treatment of various diseases of organs that are in the abdominal cavity. It is also very important to put the correct diagnosis in time for acute appendicitis and perform an operation to remove it.

Forecast

Mortality with abdominal abscess is from 10 to 40%. The prognosis depends to a large extent on how serious the background pathology is, what state of the patient, where the ulcer is located.

Last update: 25.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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