What Is An Abdominal Abscess
An accumulation of pus in any tissue in the abdominal area, usually resulting from a bacterial infection, is called an abdominal abscess.
- Fever accompanied by pain in the abdomen is the usual symptom.
- Imaging tests such as CT scan can detect abdominal abscesses.
- Antibiotic drugs are used to treat abscesses, but surgical draining may be necessary.
The location of an abscess may vary; it can occur in any of the organs of the abdominal cavity such as stomach, liver, intestines, pancreas, spleen or kidneys. It can also develop on the walls of the abdomen and on the diaphragm which separates the abdomen from the chest region.
Causes and Symptoms
When the intestine is perforated by any physical injury or due to the damage caused by intestinal cancer, it may cause abdominal abscess. Infections in any of the organs in the abdominal cavity or an infection carried by blood from elsewhere in the body to the abdominal organs also may cause abdominal abscess. People who have inflammatory conditions such as pelvic inflammatory disease or Crohn’s disease are prone to developing abdominal abscesses. Inflammation of various organs such as pancreatitis, diverticulitis and appendicitis also increase the risk of abscesses. General discomfort and pain, weight loss and weakness resulting from lack of appetite, accompanied by fever are the usual symptoms.
Diaphragm may come in contact with fluids produced by the rupture of appendix or by an infected organ in the abdomen, when the suction force created by the upward movement of the diaphragm draws the fluid up. It may transfer the infection to the diaphragm, resulting in the development of an abscess on the lower surface of the diaphragm. Pain while breathing, and cough, may be present, which are the common symptoms of an abscess on the diaphragm. Sometimes referred pain may be felt on one of the shoulders depending on the location of the abscess because a common nerve runs through both the muscles of the diaphragm and the shoulders.
Rupture of intestine or appendix, inflammatory diseases such as Crohn’s disease, leakage from diverticulas, injuries and wounds in the abdomen etc., are the usual causes of abscesses developing in the mid- abdomen area. Pain may be felt at the place where the abscess is located.
In addition to the above infections responsible for the development abscesses in the mid-section of the abdomen, infections of the reproductive organs also may cause abscesses in the pelvic region. Pain in the abdomen, diarrhea, and frequent urination due to the irritation caused to the urinary bladder, are symptoms typical of pelvic abscesses.
Retroperitoneal abscesses occur at the back of the abdomen behind the membrane called peritoneum that encloses the abdominal organs. Infections and inflammations of the abdominal organs such as pancreatitis, appendicitis diverticulitis may cause these abscesses. Lower back pain, which increases with hip movements, is the usual symptom.
Following an episode of severe pancreatitis, abscesses may develop in the pancreas causing various symptoms such as nausea and vomiting accompanied by pain in the abdomen and fever. If such symptoms develop in a week or two after a bout of pancreatitis is resolved, it often points to the development of abscesses.
In addition to bacterial infections, abscesses in the liver may result from another unicellular micro organism called amoebae too. These amoebae usually cause infections in the digestive tract but sometimes they can travel to the liver via the blood supply, causing abscesses there. Bacterial infections in the gall bladder, or in some other part of the abdomen, can cause abscesses in the liver. Infections existing in other parts far removed from the liver also can cause liver abscesses, when the bacteria is carried into the liver by the blood vessels. Injuries to the liver too may cause liver abscesses. Abdominal pain may not always be present when a person has liver abscesses but symptoms such as nausea and lack of appetite accompanied by fever usually occur.
Direct injury, or infections brought into the spleen, is the causes of abscesses developing in the spleen. An abscess on the diaphragm may spread the infection to the spleen and cause an abscess there. Pain symptomatic of abscesses on the spleen is felt on the left side of the abdomen, usually towards the back. It may be felt at the left shoulder too.
Diagnosis
Abscesses in the abdomen are not easily identified as the symptoms are mild and similar to other common stomach disorders. It may be diagnosed when doctors advise further diagnostic tests such as MRI scans or computed tomography, to detect the presence of appendicitis or some other inflammatory disease that could be causing abdominal pain and fever. An ultrasound scan also is useful in detecting abscesses. The size and location of the abscess can be determined by the same tests. Under the guidance of an imaging test like ultrasound scan or CT scan, a sample of the pus is drawn out with a needle. This sample is cultured in the laboratory to detect the causative organism. The culture and sensitivity test also helps to determine the suitable antibiotics against a particular organism.
Treatment
For the successful treatment of an abdominal abscess, drug therapy should be used along with surgical draining of the pus. Sometimes pus can be aspirated with a needle, thereby avoiding surgery. Antibiotics are used to treat the infection which is usually bacterial. However, a sample of the aspirated pus is cultured in the laboratory to identify the exact causative agent as well as the most potent drug against that particular organism. Antibiotic treatment alone is often unsuccessful in curing the condition. If the abscess is in a location not accessible for aspiration with a needle, surgery may be the only option. Occasionally, a part of the organ, such as the small intestine or the colon, where the abscess has developed, is also surgically removed.
Till normal feeding and diet are resumed, the patient may be put on supplementary feeding via intravenous administration or by a feeding tube.
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Yasser Elnahas
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