Intra-abdominal abscess - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Intra-abdominal abscess (IAA) is an intra-abdominal collection of pus or infected material, usually due to a localized infection inside the peritoneal cavity. It can involve any intra-abdominal organ or be located in between bowel loops, or be free within the peritoneal cavity itself.
Commonly presents with abdominal pain, fever, and leukocytosis.
Usually secondary to inoculation, commonly from complicated intra-abdominal infection (i.e., bowel perforation, anastomotic leak, trauma).
Diagnosis can be confirmed by radiologic studies such as ultrasound or computed tomography (CT) scan. CT scan of the abdomen and pelvis is often more reliable, and provides better delineation of anatomic location and size of the IAA.
Treatment involves adequate source control (abscess drainage, whether percutaneous or surgical) as well as early appropriate and effective antimicrobial therapy.

Abscess completely replacing pancreas and extending into portal hilum, with multiple gas bubbles and large air/fluid level

From the collection of Dr Ali F. Mallat and Dr Lena M. Napolitano; used with permission

Quick Reference

History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Intra-abdominal abscess with small air bubble, secondary to perforated diverticulitis
Classification of intra-abdominal abscesses (intraperitoneal, retroperitoneal, or visceral)
Abscess completely replacing pancreas and extending into portal hilum, with multiple gas bubbles and large air/fluid level
CT scan showing intra-abdominal abscess with small air bubble

Citations

Key Articles

Mazuski JE, Tessier JM, May AK, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017 Jan;18(1):1-76.[Abstract][Full Text]
Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010 Feb;11(1):79-109.[Abstract]
Pieracci FM, Barie PS. Intra-abdominal infections. Curr Opin Crit Care. 2007 Aug;13(4):440-9. [Abstract]
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: radiologic management of infected fluid collections. 2019 [internet publication].[Full Text]

Other Online Resources

Surgical Infection Society: intra-abdominal infection (IAI) high versus low risk

Referenced Articles

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