Intraabdominal Abscess

The manifestations of intra-peritoneal abscess that complicate appendicitis are progressive and persistent (> 36 hours) abdominal symptoms, localized peritonitis, systemic toxicity, and a palpable mass on rectal examination, or when right lower quadrant mass is palpated following illness longer than five days. Pelvic abscesses can be palpated on rectal examination. Vague upper abdominal pain and pulmonary or pleural symptoms often suggest a subphrenic location.

Liver abscesses generally present with fever accompanied by chills, malaise, sweats and aching pain and tenderness over the liver or epigastrium. Leukocytosis, anemia, hypergamma-globulinemia, elevated alkaline phosphatase, and other liver enzymes, and positive blood culture are often present. Splenic abscesses are characterized by fever, abdominal pain that is generalized or localized to the left upper quadrant.

Air fluid level outside the intestinal lumen, localized ileus, or right lower quadrant mass suggest an appendiceal abscess; presence of a soft tissue mass, loss of psoas shadow, or displacement of the ureter or bladder can suggest the presence of retroperitoneal abscess. Subphrenic abscesses are often associated with pleural effusions.

The best imaging procedure for the diagnosis of abdominal abscesses is CT (13). Ultrasonically guided fluid collection and abscess drainage are routine procedures in diagnosis and treatment of abdominal abscesses. CT and fluoroscopy with contrast often give invaluable information. Magnetic resonance imaging (MRI) and gallium (Ga-67) scan may be useful in detecting abdominal abscesses.

Roentgenographic studies for abscesses may show elevation, change in contour, and reduced mobility of the diaphragm. Left lobe liver abscess may deform the barium- or gas-filled stomach, or displace the duodenal cap. Pleural effusion or thickening also may be observed, and occasionally a gas-fluid level may be noted inside the liver.

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