Abdominal abscess: Description, Causes and Risk Factors:
An abdominal abscess is a collection of pus in the abdominal cavity. It can occur anywhere in the abdomen area (such as the stomach, liver, kidneys, or intestines). The problem is enclosed in a capsule that is made up of infected tissues. This is filled with pus (consists of dead skin cells, bacteria and blood).
In most cases, an abdominal abscess forms when another organ inside the abdomen becomes infected with bacteria.
Possible causes for an abdominal abscess include:
- Intestinal parasites.
- Intestinal perforation.
- Perforated ulcer.
- Ruptured appendix.
Other causes include untreated penetrating trauma to the abdominal viscera and postoperative complications, such as anastomotic leakage or missed gallstones during laparoscopic cholecystectomy.
Microbiology includes a mixture of aerobic and anaerobic organisms. The most commonly isolated aerobic organism is Escherichia coli (E. coli), and the most commonly observed anaerobic organism is Bacteroides fragilis. A synergistic relationship exists between these organisms. In patients who receive prolonged antibiotic therapy, yeast colonies (eg, candidal species) or a variety of nosocomial pathogens may be recovered from abscess fluids.
Skin flora may be responsible for abscesses after a penetrating abdominal injury. Neisseria gonorrhoeae and chlamydial species are the most common organisms involved in pelvic abscesses in females as part of pelvic inflammatory disease. The type and density of aerobic and anaerobic bacteria isolated from intra-abdominal abscesses depend upon the nature of the microflora associated with the diseased or injured organ.
Microbial flora of the GI tract shifts from small numbers of aerobic streptococci, including enterococci and facultative gram-negative bacilli in the stomach and proximal small bowel, to larger numbers of these species, with an excess of anaerobic gram-negative bacilli (particularly Bacteroides species) and anaerobic gram-positive flora (streptococci and clostridia) in the terminal ileum and colon.
Differences in microorganisms observed from the upper portion of the GI tract to the lower portion partially account for differences in septic complications associated with injuries or diseases to the upper and lower gut. Sepsis occurring after upper GI perforations or leaks causes less morbidity and mortality than does sepsis after leaks from colonic insults.
Symptoms of an abdominal abscess depend on its size and location. Symptoms of an abdominal abscess may include abdominal pain, abdominal swelling, and constipation or diarrhea. The infection may also cause a fever, nausea, weakness, and fatigue.Due to increased pressure and enlarged abdomen, this may press on the bladder causing bladder irritation. This can lead to symptoms such as frequent urinating and increased urge to urinate.
To confirm a certain medical condition, diagnostic tests must be done to carefully evaluate the present illness. Diagnostic tests are performed to aid the physician in his/her treatment plans and interventions. The common tests for this problem may include:
CT scan - this diagnostic test is done to assess the morphology (structure) of the abdomen and if there are any abnormal growths present. A CT scan provides 3Dimensional imagery of the internal organs. CT scans also provide cross-sectional images (horizontal and vertical slices) of organs, thus aiding the physician in identifying the specific location of any problems.
- Ultrasound of the whole abdomen - a test performed to check for growths and to assess for any defects in any of the organs.
- MRI (Magnetic Resonance Imaging) - preferred for patients without metal implants. Before the procedure, all items with metal such as bra, belt, accessories (such as necklace, earrings) are removed. This is a confirmatory test for diagnosing abdominal abscess. MRI provides detailed structure of the abdomen.
- Stool exam / Stool Culture and Sensitivity - feces is submitted to the laboratory (preferably 0 - 30 minutes after defecating for test accuracy). This is done to assess the stool formation (watery - diarrhea, hard - constipated), and also to check for the condition of the digestive track. This will aid the examiner determine the bacteria causing any abdominal abscess.
In most cases, an abdominal abscess is treated with antibiotics and drainage of the pus that forms in the abscess. Most of the time, the abscess is drained with a catheter, which is placed through the skin, and then guided to the abscess using CT scan. The catheter is removed and the abscess usually resolves in 1 to 4 weeks. In some cases, a surgeon must make an incision in the abdomen to drain the abscess.
When abscess drainage and antibiotics are ineffective, surgery will be performed. This will be done in the operating room under general anesthesia. The abdomen may be incised to access the abscess and to remove the surrounding infected tissues.
Laparoscopy - a kind of surgery done in the Operating room under general anesthesia. This is done by creating small punctures (usually 3 punctures with the size of 1 cm or less in diameter) in the abdomen. Laparoscopy is less invasive than open surgery. A camera and light source is secured in place. This is attached to the monitor for the physician to see what is inside. The other holes are for the other instruments. These instruments are special tools used by the surgeon to remove the abscess. The instruments are long and have hand graspers / controllers in the end (a laparoscopic scissor looks like a scissor, but the scissor itself is at the very tip of the instrument, and to control it, a grasper is attached at the end). Everything that is done inside can be seen in the monitor. The procedure may also be recorded in a disk and the physician may go over it for review. Laparoscopic procedure is preferred for patients with Diabetes and other medical illnesses (such as cancer, etc.), due to its faster recovery time than open abdominal surgery.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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