Abscess of the abdominal cavity: causes and consequences

A thin serous membrane - peritoneum - which in one form or another is located on most of the organs, has specific protective properties. So, for example, when an inflammation occurs, it can delineate the affected area, forming an abscess of the abdominal cavity. On medical slang, this is called "soldering," that is, the formation of adhesions between neighboring organs in such a way that a closed space is obtained.

Definition

Abscess of the abdominal cavity is a purulent inflammation of the organ or part of it, with further melting of tissues, the formation of a cavity and capsules around it. It can form absolutely in any "floor" of the abdominal cavity and is accompanied by the phenomena of intoxication, fever and sepsis.

In addition, the pain will prevail in the patient, the dysphasia of the abdominal muscles will be observed, nausea and vomiting may occur. Sometimes, in difficult cases, spikes cause intestinal obstruction.

Epidemiology

Abscess of the abdominal cavity, which is not surprising, is formed after surgical interventions and is interpreted as a complication of this type of treatment. In view of the growing number of annual surgeries, the number of such complications is also progressively increasing. A major role in this is played by a decrease in immunity and ubiquitous use of antibiotics, which forms resistance in microorganisms and hinders postoperative prophylaxis of complications.

According to the findings of extras, one per cent of surgical patients develop a postoperative abscess. This figure is higher if the intervention was urgent and there was no time for preoperative preparation.

Risk factors

The main risk factor, because of which abdominal abscess may occur, is, of course, cavitary surgery. Most often it occurs after treatment of pancreatic diseases, gall bladder, stitching of the intestine loops.

The appearance of inflammation is associated with the ingestion of the contents of the intestine on the peritoneum, as well as seeding it in the operating room. It can be caused by a blunt stomach injury. In the area of compression, aseptic inflammation is formed, to which a secondary flora is later attached.

In more than half of cases, the abscess is located either behind the parietal (parietal) leaf of the peritoneum, or between its parietal and visceral sheets.

Causes

Abscess of the abdominal cavity (ICD 10 - K65) can appear as a result of abdominal injuries, for example, prolonged compression or strokes, infectious diseases of the intestinal tube (yersiteosis, salmonella, typhoid), development of inflammatory processes in organs or mucous membranes, and after perforation Ulcers of the stomach or intestines.

There are three main reasons:

1. The presence of secondary peritonitis due to rupture of the appendix, insufficiency of intestinal anastomoses after cavitary operations, pancreatic head necrosis, abdominal trauma.
2. Purulent inflammation of the pelvic organs, for example, salpingitis, parametritis, pyosalpinx, tubo-ovarian abscess and others.
3. Acute inflammation of the pancreas and gallbladder, nonspecific ulcerative colitis.

In addition to the above, sometimes the cause of the abscess can be inflammation of the pericarp cell, osteomyelitis of the lumbar spine, tuberculous spondylitis. Most often, staphylococci, streptococci, clostridia and isherichia are sown in the inflammatory focus, that is, that flora that normally can be found in the intestine.

Pathogenesis

Abscess after the operation of the abdominal cavity appears due to excessive reaction of the immune system to interference in the internal environment or to the reproduction of microorganisms. The causative agent can enter the abdominal cavity and with blood or lymph flow, and also leak through the intestinal wall. In addition, there is always the risk of infection with the hands of the surgeon, instrumentation or materials during surgery. Another factor is the organs communicating with the external environment, such as the fallopian tubes or intestines.

It is impossible to exclude the appearance of inflammatory infiltrates after penetrating wound of the abdominal cavity, perforation of ulcers and divergence of the sutures after surgical treatment.

The peritoneum reacts to the appearance of the irritating factor (inflammation) stereotypically, namely, it produces on its surface fibrin, which glues the mucosa between each other and thus delimits the focus from healthy tissues. If, as a result of the action of pus, this protection is destroyed, then the inflammatory detritus flows into the pockets and the sloping places of the abdomen. With the development of such a scenario, we are already talking about sepsis.

Symptoms

What happens to a person when he develops an abscess of the abdominal cavity? Symptoms are similar to any inflammatory disease:

1. A high, sudden onset of fever accompanied by chills and profuse sweat.
2. Drawing pains in the abdomen, which are strengthened by touching or pressing.
3. Frequent urination, as the peritoneum stretches and it irritates the baroreceptors of the bladder wall.
4. Violations of the stool in the form of constipation.
5. Nausea and vomiting at fever altitude.

In addition, the patient may have heart palpitations. It occurs for two reasons: high temperature and intoxication. And as pathognomonic symptom is the tension of the muscles of the press. This is a protective reflex, which does not allow further injury to the inflamed area.

If the abscess is located directly below the diaphragm, then in addition to general symptoms there will be those that point to this feature. The first difference is that the pain is localized in the subcostal area, intensified during inspiration and irradiates into the scapula area. The second difference is a change in gait. A person begins to unwittingly save the sick side and leans toward it to reduce muscle tension.

Complications

Abscess of the abdominal cavity (ICD 10 - K65) may remain unrecognized if it develops against the background of other severe conditions, or the patient does not seek help. But it should be remembered that as a result of this negligent behavior, life-threatening conditions such as sepsis and diffuse peritonitis can develop.

Sub-diaphragmatic abscesses can melt the diaphragm and break into the pleural cavity, forming spikes there. Such a scenario can even lead to damage to the lung. Therefore, if after the operation or injury you have a fever or pain, do not expect that everything will pass by itself. In this issue, an extra check does not hurt.

Diagnostics

Postoperative abscess of the abdominal cavity in a hospital can be easily detected. The most informative methods are X-ray, ultrasound, CT and MRI of the organs of the chest and abdomen. In addition, it is possible for women to make a puncture of the vaginal vault to check if there are purulent fouling in sheltered places.

In addition, do not forget about the laboratory diagnosis. In the general blood test, there will be a sharp increase in the rate of erythrocyte sedimentation (ESR), the leukocyte formula will have a sharp shift to the left, perhaps even to young forms, and the absolute number of leukocytes will increase due to neutrophils.

The standard in the diagnosis of abscesses remains ultrasound examination of the abdominal cavity. There are clear signs that indicate the presence of an inflammatory infiltrate:

• Education has clear contours and a dense capsule;
• There is liquid inside;
• The content is heterogeneous in structure and is divided into layers;
• Over the liquid there is gas.

Treatment of abscesses of the abdominal cavity

The main method of treating abscesses, of course, is surgical intervention. It is necessary to drain the abscess, rinse the cavity with an antiseptic and a solution of antibiotics. Conservative treatment does not give any guarantee that the inflammation will subside, and the fluid inside the abscess will be evacuated independently.

Of course, after the outbreak has been removed, the patient is required to prescribe antimicrobial therapy with broad-spectrum antibiotics. As a rule, the doctor prescribes simultaneously two drugs that have different mechanisms of action and effectively destroy different representatives of the microbial flora.

Be sure to warn the patient about the possible consequences of this treatment, such as vomiting, lack of appetite, inflammation of the papillary layer of the tongue, headaches and frequent urination. Yes, and the doctor himself is to remember them and not add them to the clinical picture of the disease.

Prognosis and prevention

Abscess of the abdominal cavity (ICD code 10 - K65) is quite a serious complication, so doctors and patients should take care of the prevention of this condition. It is necessary to adequately and fully treat inflammatory diseases of any abdominal organs, it is necessary to conduct pre- and post-operation training of patients, as well as sterilize the instruments and hands of the surgeon.

If you suspect an appendicitis or in case of a sudden rise in temperature, you should not wait for a sign from above, but you should immediately consult a doctor for advice. It can save you life and health.

Mortality from abdominal abscess reaches forty percent. It all depends on how widespread the process is, where it is located and what disease it caused. But with timely access to the hospital the probability of an unfavorable outcome is reduced.