Intraabdominal Abscesses

Abstract

Intraabdominal abscesses continue pose challenge to surgeons due to their rather ominous presentation. Most often, high index of suspicion is required to initiate a diagnostic workup. The discovery of a wide variety of antibiotics, more aggressive surgical drainage techniques, intensive care management, and other factors have decreased mortality below 25% over the past century. Recently, more conservative, less invasive source control techniques have recently been developed. These include laparoscopic, needle, and percutaneous image-guided drainage techniques. This chapter will discuss the epidemiology of intraabdominal abscesses including frequency of occurrence of the various types and age and sex distribution. Relevant anatomy of the peritoneal cavity will be given. Risk factors will be discussed. Classification will include intraperitoneal, solid organ abscesses and retroperitoneal abscesses. Pathology and pathophysiology of the various types of abscesses will be discussed followed by clinical presentation, morbidity and complications. Aetiology and bacteriology of the abscess types will be elaborated. A discussion will be provided on resuscitation, patient evaluation and preoperative workup. Management will be discussed as follows: Overview, percutaneous image-guided drainage vs. open drainage, (including indications, anaesthesia, access and technique of drainage), pearls and postoperative/postprocedural care and complications. Prognosis of each abscess type will be given.