Abdominal Abscesses
An abscess is a pocket of pus, usually caused by a bacterial infection.
Abdominal abscesses may form below the diaphragm, in the middle of the abdomen, in the pelvis, or behind the abdominal cavity. Abscesses also may form in or around any abdominal organ, such as the kidneys, spleen, pancreas, or liver, or in the prostate gland. Often, abdominal abscesses are caused by injury, infection or rupture of the intestine, or infection of another abdominal organ.
Causes and Symptoms
An abscess below the diaphragm may form when infected fluid, for example, from a ruptured appendix, is moved upward by the pressure of abdominal organs and by the suction created when the diaphragm moves during breathing. Symptoms may include a cough, painful breathing, and pain in one shoulder--an example of referred pain that occurs because the shoulder and the diaphragm share the same nerves, and the brain incorrectly interprets the source of the pain (see Section 6, Chapter 78).
Abscesses in the midabdomen may result from a ruptured appendix, a ruptured intestine, inflammatory bowel disease, diverticular disease, or an abdominal wound. The abdomen is usually painful in the area of the abscess.
Pelvic abscesses can result from the same disorders that cause abscesses in the midabdomen or from gynecologic infections. Symptoms may include abdominal pain, diarrhea from intestinal irritation, and an urgent or frequent need to urinate caused by bladder irritation.
Abscesses behind the abdominal cavity (called retroperitoneal abscesses) lie behind the peritoneum, the membrane that lines the abdominal cavity and organs. The causes, which are similar to those of abscesses in the abdomen, include inflammation and infection of the appendix (appendicitis) and of the pancreas (pancreatitis). Pain, usually in the lower back, worsens when the person moves the leg at the hip.
Abscesses inside the pancreas typically form after an attack of acute pancreatitis. Symptoms such as fever, abdominal pain, nausea, and vomiting often begin a week or more after a person recovers from pancreatitis.
Liver abscesses may be caused by bacteria or by amebas (single-celled parasites). Bacteria can reach the liver from an infected gallbladder; a penetrating or blunt wound; an infection in the abdomen, such as a nearby abscess; or an infection carried by the bloodstream from elsewhere in the body. Amebas from an intestinal infection reach the liver through the lymph vessels. Symptoms of liver abscesses include loss of appetite, nausea, and a fever. A person may or may not have abdominal pain.
Abscesses in the spleen are caused by an infection traveling through the bloodstream to the spleen, by an injury to the spleen, or by the spread of an infection from a nearby abscess, such as one below the diaphragm. Pain may occur in the left side of the abdomen, the back, or the left shoulder.
Diagnosis and Treatment
Doctors can easily misdiagnose an abscess, because the symptoms are commonly caused by less serious problems. When a person has an abscess, blood tests often reveal an abnormally large number of white blood cells. X-rays, ultrasound scanning, computed tomography (CT), or magnetic resonance imaging (MRI) can be used to distinguish an abscess from other problems (for example, tumors or cysts), as well as to determine the size and position of an abscess once it has been diagnosed. Because abscesses and tumors often cause the same symptoms and produce similar results on imaging tests, a definitive diagnosis sometimes requires that a doctor obtain a sample of the pus or surgically remove the abscess for examination under a microscope.
In nearly all people with an abdominal abscess, the pus must be drained, either by surgery or by a needle inserted through the skin. To guide the placement of the needle, a doctor uses CT or ultrasound scanning. Antibiotics are usually used in conjunction with drainage to prevent the infection from spreading and to help completely eliminate the infection. Laboratory analysis of the pus identifies the infecting organism so that the most effective antibiotic can be selected. It is uncommon for antibiotics to cure an abscess without drainage.
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