INTRAPERITONEAL ABSCESS FORMATION

INTRAPERITONEAL ABSCESS FORMATION

An intraperitoneal abscess is a collection of pus in the peritoneal cavity ( Figure 65.10 ). It normally arises secondary to another - pathology . Inflammation of any viscus, if unresolved, will lead to hypersecretion of peritoneal fluid. The nature of the fluid progresses to frank pus unless adsorbed or drained. Hence, - abscess formation commonly accompanies inflammation of an abdominal viscus and is usually labelled either according to location (subphrenic, intrapelvic) or with reference to nearby organs (periappendiceal, paracolic, subhepatic). - Intraperitoneal abscess formation is associated with a spectrum of symptoms and signs. At one end, patients may be asymptomatic or may feel somewhat unwell, anorectic, fatigued, with failure to maintain or gain weight. At the oppo - - site end, patients may have significant abdominal symptoms and signs (nausea, vomiting, abdominal pain, diarrhoea) and - be extremely unwell. A swinging pyrexia is strongly suggestive of intraperitoneal abscess for mation. Summary box 65.8 Clinical features of an abdominal/pelvic abscess /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Figure 65.9 Computed tomography axial scan of the abdomen show

ing gross ascites. Symptoms Malaise, lethargy – failure to recover from surgery as expected Anorexia and weight loss Sweats +/– rigors Abdominal/pelvic pain Symptoms from local irritation, e.g. shoulder tip/hiccoughs (subphrenic), diarrhoea and mucus (pelvic), nausea and vomiting (any upper abdominal) Signs Increased temperature and pulse +/– swinging pyrexia Localised abdominal tenderness +/– mass (including on pelvic examination)

Figure 65.10 Intraperitoneal abscesses. (a) and (b) Subphrenic and subhepatic abscesses seen on computed tomography (CT) scanning. (c) Pelvic abscess seen on CT scanning.