An abscess is pocket of pus surrounded by the inflamed tissue. Generally people are aware of skin abscess but it can develop anywhere in the body, including in the abdomen. An abscess in the abdomen can be inside the peritoneum, under the diaphragm or outside the peritoneum. It can also develop in abdominal organs such as the liver, appendix, pancreas, etc.
Mostly, abdominal abscess is caused due to bacterial infection resulting from perforation of the intestine, injury to any abdominal organ, cancer, or a puncture in the ulcer. Intra-abdominal abscess is common occurrence in conditions like appendicitis, diverticulitis, pancreatitis and pelvic inflammatory disease if they are left untreated or there is delay in the treatment.
Severe abdominal pain, high fever, toxic appearance of face, loss of appetite, general lassitude, tenderness in abdomen are some characteristic features of abdominal abscess. Abdominal abscess is a serious condition which needs immediate treatment. Untreated cases can increase the risk of mortality due to sepsis.
What Causes Intra-Abdominal Abscess?
Intra-abdominal abscess can develop due to vide variety of conditions.
In majority of cases it is caused due to bacterial infection, however sometimes the causative organism can be fungi especially in patients with compromised immunity or those who are taking antibiotics for long period. Amoeba is a protozoa usually infecting the intestine. However, if it enters the bloodstream it can land up in the liver to cause amoebic liver abscess.
Signs And Symptoms Of Intra-Abdominal Abscess
Some of the symptoms are generalized for any type of intra-abdominal abscess while some symptoms may vary depending on the organ involved. In all cases the general clinical features will be severe abdominal pain, abdominal tenderness, guarding of the abdomen, high grade fever, loss of appetite, toxic appearance of the patient, inability to move due to pain in abdomen, cannot bend forward as a result of severe pain and tenderness, rigors, loss of weight etc.
Few symptoms are organ specific. For example if there is a diaphragmatic abscess patient will experience dry cough, breathing difficulty, pain in chest while breathing, pain radiating to the shoulder due to common nerve involvement.
Vomiting, nausea, jaundice, including the general symptoms such as abdominal pain, high fever with chills, and tenderness over liver area etc is presenting feature of amoebic liver abscess.
Diagnosis And Treatment For Intra Abdominal Abscess
Diagnosis of intra-abdominal abscess today is not as difficult as it used to be before invention of modern imaging techniques such as CT scan, ultrasound, and MRI. If the physician suspects intra-abdominal abscess from medical history, symptoms and examination, he will recommend for certain medical tests such as blood examination and imaging. Even a small abscess can be easily detected on CT or MRI imaging techniques. Blood tests will show raised white blood cell count and ESR. Often a large abscess in the abdomen can be felt on examination of the abdomen.
Abscess in abdomen needs urgent medical treatment. If the condition is left untreated it can lead to serious and life threatening sepsis which can increase the mortality rate. The mainstay treatment of abdominal abscess is surgical drainage and intravenous antibiotics. The collected pus in the pouch needs to be drained.
A large bore needle is used to drain the pus under the guidance of C –arm or sonogram or CT. In this way the needle can reach at an accurate point of the abscess without causing damage to the adjacent organs. If the pus is thick and cannot be drained, open surgery may be required to remove the pus.
Once the pus is removed from the cavity, the source of infection is also treated simultaneously. The use of antibiotics will help to eliminate the organism responsible for infection.