Abdominal Abscess - Causes, Types, Symptoms, and Treatment

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:

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.

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  Appendicitis

• 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.