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Abdominal Abscess - Causes, Types, Symptoms, and Treatment

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An abdominal abscess is a localized collection of pus surrounded by inflamed tissues in the abdominal cavity. Read the article to learn more.

Written by

Dr. Anahita Ali

Medically reviewed by

Dr. Ghulam Fareed

Published At September 29, 2022
Reviewed AtMarch 17, 2023

Introduction:

An abscess is a collection of pus and fluids developed due to a bacterial infection. This condition causes pain, swelling, and tenderness in the affected area of the body. An abscess can occur in any part of the body, internal or external.

When an abscess occurs in the abdomen of the human body, it is called an abdominal abscess. The abdomen is commonly called the belly and is the area between the chest and pelvis. It contains many vital organs such as the stomach, intestines, liver, gallbladder, etc. the space between these organs is the peritoneal cavity where the abscess develops.

What Is Abdominal Abscess?

It is a pocket filled with pus or a localized collection of pus surrounded by inflamed tissues in the abdominal cavity of the human body. It is also called an intra-abdominal abscess or intraperitoneal abscess.

An abscess is a collection of pus caused by bacterial infections and results in pain. It can be present in any area, structure, or organ of the abdomen, such as the liver, stomach, intestines, or peritoneal cavity (spaces between the organs).

What Are the Classifications of Abdominal Abscess?

The classification of abdominal abscess is as follows:

classification of abdominal abscess

What Causes Abdominal Abscess?

The common causes of abdominal abscesses are:

  • Bacterial Infection - A reaction or infection in the body caused by the bacterial entry. The favorable conditions or environment within the body supports bacterial growth. Generally, the bacteria enter through a cut in the skin, such as a wound or through a surgery site.

  • Gastric Ulcer Perforation - It is a sore formed on the lining of the stomach or intestine.

  • Perforated Appendicitis - Infection of the appendix that spreads into other body parts and organs. It occurs due to the blockage of the appendix opening resulting in swelling and infection.

  • Diverticulitis - It is the inflammation of the diverticula, which are small bulges on the lining of the intestine.Ischemic bowel disease.

  • Pancreatic Necrosis - Necrosis of the pancreas resulting from the compromised blood supply.

  • Trauma - It is an injury to the abdomen due to falling, an accident, etc.

  • Trauma From Surgery - Any injury developed due to another major surgery.

  • Anastomotic Leakage - Leakage of fluids from anastomosis (a surgical connection between two structures).

  • Volvulus - A condition in which the bowel twists and causes obstruction in the bowel movement.

  • Missed Gallstone During Cholecystectomy - It means that gall stones is spilled or missed during the procedure, and it migrates to another place resulting in pus formation (abscess).

  • Intussusception - A condition in which a part of the intestine folds into another part of the intestine, causing obstruction or telescoping itself.

Which Bacteria Causes Abdominal Abscess?

Bacteria that commonly cause abdominal abscesses are;

  • Escherichia coli.

  • Bacteroides.

  • Neisseria.

  • Chlamydia.

  • Candida.

What Are the Abdominal Abscess Symptoms?

The common symptoms are;

  • Pain in the stomach or abdomen.

  • Fever.

  • Tachycardia is an increased heart rate than normal.

  • Ileus is a loss of muscle contraction in the intestines.

  • Abnormal weight loss.

  • Loss of appetite.

How to Diagnose Abdominal Abscess?

  1. Physical Examination: A palpable mass may or may not be present in the abdomen. The doctor will also check the pain and tenderness in the same region.

  2. Lab Test: Blood tests do not help identify the abscess and/or confirm the abdominal abscess. It may only indicate the presence of bacterial infection such as abnormal liver function, anemia, etc.

  3. Blood Culture: It only indicates the type of microorganism present in the blood. Most of the time, these are negative.

  4. Imaging Tests: X-rays do not help identify abdominal abscesses. Computed tomography (CT) is the most definitive diagnostic tool for this purpose as it shows the size, shape, and location of the abdominal abscess. It also reveals large bowel wall thickening (thumbprinting) and ileus. Other tools such as magnetic resonance imaging (MRI) and ultrasound may be used.

How to Treat Abdominal Abscess?

  1. Antibiotic Therapy: Antibiotics help manage bacterial infection, support the healing process, and prevent bacteremia. The therapy should be initiated after suspecting the abdominal abscess. Once the pus is drained completely, the antibiotics should be stopped or discontinued.

  2. Drainage: The most common treatment approach for an abdominal abscess is percutaneous computed tomography-guided drainage. It is a minimally invasive method done under local anesthesia. Multiple needles are inserted into the affected area to get access to the pus or abscess. These needles are placed with the help of a computed tomography scan that guides the exact location. The fluid from the abscess is drained out through needles. Sometimes the drainage catheter is left after drainage and is removed later. It is a thin plastic tube that helps the drain to collect into a bag.

  3. Abdominal Abscess Surgery: When the drainage is not appropriate or suitable, then surgical management of the abdominal abscess is required. It includes the following options:

  • Exploratory Laparotomy: It is a rarely used method of drainage in which a blind laparotomy is done to find or explore the abscess.

  • Direct Surgery: It is open surgery in which an incision is made on the abdomen to get access to the abscess; the abscess is drained, and all necrotic tissues are removed.

What Happens if the Abdominal Abscess Is Left Untreated?

If left untreated, it leads to sepsis shock - a serious condition in which bacterial infections spread in the body, causing organ failure and low blood pressure.

How to Flush Abdominal Abscess Drain?

If a drainage catheter is left, then flush it with 10 ml sterile saline two or three times a day.

What Are the Complications of Abdominal Abscess?

  • Sepsis Shock - A serious condition in which bacterial infections spread in the body, causing organ failure and low blood pressure.

  • Failure of Multiple Organs - It is a life-threatening condition affecting different organs of the body and eventually results in death.

  • Fistula Formation - An abnormal connection between organs and the skin.

  • Death - Loss of life.

  • Bowel Perforation - A hole or puncture in the small intestine.

  • Deep Vein Thrombosis - Formation of blood clots in the body veins.

  • Malnutrition - Deficiency of nutrition.

Conclusion:

The success rate or prognosis of abdominal abscess treatment is high. Computed tomography-guided drainage is a definitive method and offers a low death rate. It is important to avoid misdiagnosing the abdominal abscess and/or leaving the condition untreated because it may lead to various life-threatening health conditions and even death. Antibiotics are helpful during the initial phase of the treatment when a suspected case of abdominal abscess is not confirmed. Once the pus is drained completely, the antibiotics must be stopped or discontinued.

Frequently Asked Questions

1.

Is Abdominal Abscess a Serious Condition?

If left untreated, an abdominal abscess can quickly become fatal and has significant morbidity. Abdominal abscesses can originate from an infectious or non-infectious source and contain cellular debris, enzymes, and liquid. They can appear almost anywhere in the abdomen and are a common and serious condition. However, the majority are restricted to a specific area of the peritoneal cavity.

2.

How Long Does It Take for an Abdominal Abscess to Heal?

Treatment options for abdominal abscesses include antibiotics, pus drainage, or both. Antibiotics will be given to treat the abscess for up to 4 to 6 weeks. The majority of patients experience improvement 48 hours after drainage. CT-guided drainage has a success rate of more than 90 % in treating localized abscesses. Surgical consultation is necessary if the patient's condition does not improve within 24 to 48 hours.

3.

How Long Does Abdominal Abscess Drainage Take?

Usually, the drainage process takes between 20 and 60 minutes to complete. The catheter is then secured in place and linked to an external drainage bag. The catheter stays in place until the fluid has stopped draining and the infection has subsided. The abscess cavity is frequently left with a drainage catheter after it has been drained. The healthcare team will examine this and take it out as needed.

4.

How Quickly Can an Abdominal Abscess Grow?

Abscesses can develop within a week of perforation or significant peritonitis, but postoperative abscesses are less common and can take up to three weeks or even months to occur. Although symptoms differ, most abscesses result in fever and mild-to-severe abdominal pain. It is possible to develop either a generalized or localized paralytic ileus. Weight loss, anorexia, and nausea are frequent.

5.

Can Abdominal Abscesses Be Painful?

Although symptoms may differ, most people typically have a fever and constant mild-to-severe abdominal pain. In addition, it is possible to develop either a generalized or localized paralytic ileus. Weight loss, anorexia, and nausea are the other symptoms.

6.

How Big Abdominal Abscesses Should Be Drained?

Most abdominal abscesses must be surgically or non-surgically drained of their pus (catheter). A doctor uses CT or ultrasound scanning to direct the needle placement and catheter. The needle is removed, but the catheter is left in place once the doctor knows the device has reached the abscess. Over several days to weeks, the pus usually drains out through the catheter.

7.

Which Antibiotics Are Used for Abdominal Abscesses?

Antibiotics treat an infection that could result in an intra-abdominal abscess. But once the abscess has formed, antibiotics are less effective as a treatment. Antibiotics are typically administered in addition to draining the abscess, though. Abdominal abscess can be treated with  Ertapenem as a single medication or Metronidazole in combination with Cefotaxime or Ceftriaxone. These antibiotics are the suggested regimens for patients at low risk of community-acquired infections. The following regimens are suggested for high-risk patients with a community-acquired infection: Piperacillin/Tazobactam, Cefepime plus Metronidazole, Imipenem/Cilastatin, or Meropenem.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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