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Intra-abdominal abscess

What's new

Added 2024 IDSA, 2024 AGA, 2021 WSES/AAST, 2021 CDC, and 2020 ASCRS guidelines for the diagnosis and management of intra-abdominal abscesses.

Background

Overview

Definition
Intra-abdominal abscesses are localized collections of pus within the abdominal cavity, often resulting from an intra-abdominal infection or a perforation of the gastrointestinal tract.
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Pathophysiology
Intra-abdominal abscesses commonly occur as complications of intra-abdominal infections, such as diverticulitis (diverticular abscess), appendicitis (periappendiceal abscess), IBD, pelvic inflammatory disease (tubo-ovarian abscess), or following abdominal surgery, gastrointestinal tract perforation, or penetrating abdominal trauma. Abscesses confined to single organs or structures can also occur, such as in the liver (pyogenic or amebic), spleen, subphrenic area, or psoas muscle.
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Disease course
Intra-abdominal abscesses often present with abdominal pain, fever, tachycardia, tachypnea, and leukocytosis. A palpable abdominal mass, peritoneal findings, ileus, and anorexia may also be present.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of intra-abdominal abscess are prepared by our editorial team based on guidelines from the American Gastroenterological Association (AGA 2024), the European Crohn's and Colitis Organisation (ECCO 2024), the Infectious Diseases Society of America (IDSA 2024), the Academy of Emergency Medicine and Care (AcEMC/SIFIPAC/SICUT/WSES/ACOI/SICG 2022), the Center for Disease Control (CDC 2021), ...
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Classification and risk stratification

Risk assessment: as per IDSA 2024 guidelines, assess disease severity for risk stratification in patients with complicated intra-abdominal infections. Consider using the APACHE II as the preferred severity of illness score for risk stratification within 24 hours of hospital or ICU admission in adult patients with complicated intra-abdominal infection, if a severity of illness score is used.
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Diagnostic investigations

Diagnostic imaging: as per IDSA 2024 guidelines, consider obtaining abdominal CT as the initial diagnostic imaging in non-pregnant adult and adolescent patients with suspected acute intra-abdominal abscess.
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  • Blood cultures

Diagnostic procedures

Intra-abdominal culture: as per IDSA 2024 guidelines, consider obtaining intra-abdominal cultures to guide antimicrobial therapy in adult and pediatric patients with complicated intra-abdominal infections undergoing a procedure for source control.
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Specific circumstances

Pregnant patients: as per IDSA 2024 guidelines, consider obtaining ultrasound or MRI as the initial diagnostic imaging in pregnant patients with suspected acute intra-abdominal abscess.

More topics in this section

  • Patients with postoperative abscess

  • Patients with periappendiceal abscess (primary prevention)

  • Patients with periappendiceal abscess (surgery)

  • Patients with periappendiceal abscess (percutaneous drainage)

  • Patients with diverticular abscess (small abscesses)

  • Patients with diverticular abscess (large abscesses)

  • Patients with diverticular abscess (elective resection)

  • Patients with diverticular abscess (elderly patients)

  • Patients with Crohn's disease (diagnostic imaging)

  • Patients with Crohn's disease (antibiotics and drainage)

  • Patients with Crohn's disease (anti-inflammatory therapy)

  • Patients with Crohn's disease (parenteral nutrition)

  • Patients with tubo-ovarian abscess (setting of care)

  • Patients with tubo-ovarian abscess (antibiotics)

  • Patients with tubo-ovarian abscess (drainage)

  • Patients with liver abscess (diagnostic imaging)

  • Patients with liver abscess (management)

  • Patients wirh vascular graft infection