Intraperitoneal abscesses

Abscesses can form in any part of the abdominal cavity and retroperitoneal space. Intraperitoneal abscesses are mainly the result of operations, injuries or certain conditions that cause infection of the abdominal cavity and inflammation, especially in cases of peritonitis or perforations. Symptoms of intraperitoneal abscesses include malaise, fever and abdominal pain. The diagnosis is established by CT. Treatment of intraperitoneal abscesses involves drainage of the abscess by the open method or transdermally. Antibiotic therapy is used as the second most important method.

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What causes intraperitoneal abscesses?

Intraperitoneal abscesses are classified into intraperitoneal, retroperitoneal and visceral. Most intra-abdominal abscesses are formed due to perforation of hollow organs or malignant tumors of the large intestine. Others arise because of the spread of infection or inflammation in a number of diseases, such as appendicitis, diverticulitis, Crohn's disease, pancreatitis, pelvic inflammatory disease, and as a consequence of other causes of common peritonitis. Abdominal surgery, especially on the organs of the digestive or biliary tract, is a significant risk factor: the peritoneum can be contaminated during or after the intervention under conditions such as, for example, anastomosis failure. Traumatic abdominal injuries - mainly ruptures and hematomas of the liver, pancreas, spleen and intestines - lead to the development of abscesses, whether or not the operation was performed.

Infection is usually a normal microflora, the intestine, constituting a complex complex of anaerobic and aerobic bacteria. The most frequent secreted microorganisms are aerobic gram-negative bacilli (eg, Escherichia coli and Klebsiella ) and anaerobes (especially Bacteroides fragilis).

Undrained abscesses can spread to adjacent structures, cause arrows by a number of located vessels (causes of bleeding or thrombosis), break into the abdominal cavity or lumen of the gut or form external fistulas. Sub-diaphragmatic abscesses can erupt into the chest cavity, causing empyema, lung abscess or pneumonia. Abscess of the spleen is a rare cause of prolonged bacteremia in endocarditis, despite the constant appropriate therapy with antibiotics.

Symptoms of intraperitoneal abscesses

Intraperitoneal abscesses can form within 1 week after perforation or pronounced peritonitis, whereas postoperative abscesses are formed no earlier than 2-3 weeks after surgery and often for several months. Although the manifestations are variable, most abscesses are accompanied by fever and discomfort in the abdomen, from minimal complaints to severe manifestations (usually in the abscess zone). Paralytic intestinal obstruction, generalized or local, may develop . Nausea, anorexia and weight loss are characteristic.

Abscesses of the Douglas space, adjacent to the large intestine, can cause diarrhea; located near the bladder, can cause rapid and painful urination.

Subdiaphragmatic abscesses can cause symptoms of the pathology of the chest, such as an unproductive cough, chest pain, shortness of breath and shoulder pain. Ravings or a noise of friction of the pleura may be heard. Dullness with percussion and a decrease in respiratory noise are characteristic for basilar atelectasis, pneumonia or pleural effusion.

Common is soreness in palpation in the zone of localization of the abscess. Large abscesses can be palpated as a volume formation.

Diagnosis of intraperitoneal abscesses

CT of the abdominal cavity and pelvis with oral contrast is the leading diagnostic method for suspected abscess. Other instrumental studies may indicate certain changes; conventional abdominal imaging can visualize the presence of gas in the abscess, the displacement of adjacent organs, the density of the tissue representing the abscess, or the disappearance of the lumbar muscle. Abscesses near the diaphragm can cause changes in the chest X-ray, such as pleural effusion on the side of the abscess, high standing and immobility of the diaphragm on the one hand, infiltration of the lower lobe and atelectasis.

It is necessary to perform a general blood test and a blood culture for sterility. Most patients have leukocytosis and anemia.

Sometimes a radionuclide scan of leukocytes labeled with In ¹¹¹ can be informative in the identification of intra-abdominal abscesses.

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Treatment of intraperitoneal abscesses

All intra-abdominal abscesses require drainage, either by percutaneous drainage, or by an open method. Draining with a tube (performed under the control of CT or ultrasound) can be performed under the following conditions: an abscess cavity is present; the course of the drain does not cross the intestine or contaminate the organs, pleura, or peritoneum; the source of contamination is delimited; pus liquid enough to be evacuated through the drainage tube.

Antibiotics are not the main remedy, but they contribute to the prevention of hematogenous infection and should be prescribed before and after the intervention. Treatment of intraperitoneal abscesses requires the use of drugs that are active against intestinal flora, for example a combination of aminoglycosides (gentamicin 1.5 mg / kg every 8 hours) and metronidazole 500 mg every 8 hours. Also, monotherapy with cefotetan 2 g every 12 hours is advisable. Patients who have previously received antibiotics or patients with nosocomial infection should be prescribed drugs that are active against persistent aerobic gram-negative bacilli (eg Pseudomonas ) and anaerobes.

Food support with enteral feeding is important. If enteral nutrition is not possible, parenteral nutrition should be given as early as possible.

What prognosis do intraperitoneal abscesses have?

Intra-abdominal abscesses result in 10-40% lethality. The result depends mainly on the patient's primary illness, the nature of the trauma and the quality of care, and not on the specific features and localization of the abscess.