A thin serous membrane - the peritoneum, - which in one form or another is located on most of the organs, has specific protective properties. So, for example, when inflammation occurs, it can delimit the affected area, forming an abscess of the abdominal cavity. On medical slang, this is called “soldering”, that is, the formation of adhesions between adjacent organs in such a way that an enclosed space is obtained.
Definition
An abscess of the abdominal cavity is a purulent inflammation of an organ or its part, with further melting of tissues, the formation of a cavity and capsule around it. It can form in absolutely any “floor” of the abdominal cavity and be accompanied by intoxication, fever and sepsis.
In addition to this, pain will prevail in the patient, abdominal muscle defenses will be observed, nausea and vomiting are possible. Sometimes, in difficult cases, adhesions cause intestinal obstruction.
Epidemiology
An 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. Due to the increase in the number of operations performed annually, the number of such complications is also progressively increasing. A major role in this is played by a decrease in immunity and the widespread use of antibiotics, which forms resistance in microorganisms and complicates the postoperative prevention of complications.
According to statisticians, one percent 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 due to which an abdominal abscess may occur is, of course, abdominal surgery. Most often, it occurs after treatment of diseases of the pancreas, gall bladder, stitching of intestinal loops.
The appearance of inflammation is associated with the ingestion of intestinal contents on the peritoneum, as well as its seeding in the operating room. It can also be caused by blunt trauma to the abdomen. Aseptic inflammation forms at the site of compression, to which secondary flora later joins.
In more than half the cases, an abscess is located either behind the parietal (parietal) sheet of the peritoneum, or between its parietal and visceral sheets.
Causes
An abdominal abscess (ICD 10 - K65) can occur as a result of abdominal injuries, for example, prolonged compression or shock, infectious diseases of the intestinal tube (yersiteosis, salmonella, typhoid fever), the development of inflammatory processes in organs or mucous membranes, as well as after perforation stomach or intestinal ulcers.
There are three main reasons:
- The presence of secondary peritonitis due to rupture of the appendix, insolvency of intestinal anastomoses after abdominal operations, pancreatic head necrosis, and abdominal injury.
- Purulent inflammation of the pelvic organs, for example, salpingitis, parametritis, pyosalpinx, tubo-ovarian abscess and others.
- Acute inflammation of the pancreas and gall bladder, ulcerative colitis.
In addition to the above, sometimes the cause of the abscess may be inflammation of the perinephric fiber, osteomyelitis of the lumbar spine, tuberculous spondylitis. Most often, staphylococci, streptococci, clostridia and Isherichia are sown in the focus of inflammation, that is, that flora, which can normally be found in the intestine.
Pathogenesis
An abscess after surgery of the abdominal cavity appears due to an excessive reaction of the immune system to interference in the internal environment or to the multiplication of microorganisms. The causative agent can enter the abdominal cavity and with the flow of blood or lymph, as well as seep through the intestinal wall. In addition, there is always a risk of infection with the hands of the surgeon, instruments or materials during surgery. Another factor is organs that communicate with the external environment, such as the fallopian tubes or intestines.
The occurrence of inflammatory infiltrates after a penetrating wound of the abdominal cavity, perforation of ulcers and divergence of sutures after surgical treatment cannot be ruled out.
The peritoneum reacts to the appearance of an irritating factor (inflammation) stereotypically, namely, it produces fibrin on its surface, which glues parts of the mucous membrane together and thus delimits the focus from healthy tissues. If, as a result of the action of pus, this protection is destroyed, then inflammatory detritus flows into the pockets and sloping places of the abdomen. With the development of such a scenario, they are already talking about sepsis.
Symptoms
What happens to a person when an abdominal abscess forms? Symptoms are similar to any inflammatory disease:
- High, suddenly started fever accompanied by chills and profuse sweat.
- Drawing pains in the abdomen, which are aggravated by touching or pressing.
- Rapid urination, since the peritoneum is stretched and this irritates the baroreceptors of the bladder wall.
- Violations of the stool in the form of constipation.
- Nausea and vomiting at the height of a fever.
In addition, the patient may have a rapid heartbeat. It occurs for two reasons: high fever and intoxication. And also a pathognomonic symptom is tension in the abdominal muscles. This is a protective reflex that does not allow even more injury to the inflamed area.
If the abscess is located directly below the diaphragm, then in addition to the general symptoms, there will be those that indicate this feature. The first difference is that the pain is localized in the hypochondrium, intensifies during inspiration and radiates to the scapular region. The second difference is the change in gait. A person begins to involuntarily take care of the sick side and leans toward it to reduce muscle tension.
Complications
An abdominal abscess (ICD 10 - K65) may remain undiagnosed if it develops against the background of other serious conditions, or the patient does not seek help. But it should be remembered that as a result of such negligent behavior, life-threatening conditions such as sepsis and diffuse peritonitis can develop .
Subphrenic abscesses are able to melt the diaphragm and break into the pleural cavity, forming commissures there. Such a scenario may even cause lung damage. Therefore, if after an operation or an injury you have a fever or pain, do not expect everything to pass by itself. In such a question, an extra check will not hurt.
Diagnostics
Postoperative abdominal abscess in a hospital is easy to identify. The most informative methods are x-rays, ultrasound, CT and MRI of the chest and abdomen. In addition, it is possible for women to have a vaginal fornix puncture to check if there are purulent streaks in the sloping places.
In addition, do not forget about laboratory diagnostics. In a general blood test, a sharp increase in the erythrocyte sedimentation rate (ESR) will be observed, the leukocyte formula will have a sharp shift to the left, possibly even to young forms, and the absolute number of leukocytes will increase due to neutrophils.
The standard in the diagnosis of abscesses remains an ultrasound examination of the abdominal cavity. There are clear signs that indicate the presence of inflammatory infiltrate:
- the formation has clear contours and a dense capsule;
- there is a liquid inside it;
- the content is heterogeneous in structure and is divided into layers;
- there is gas above the liquid.
Treatment of abdominal abscesses
The main treatment for abscesses, of course, remains surgery. 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 evacuate on its own.
Of course, after the focus is removed, the patient must be prescribed antimicrobial therapy with broad-spectrum antibiotics. As a rule, a doctor prescribes simultaneously two drugs that have a different mechanism 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 rapid urination. And the doctor himself should remember them and not add them to the clinical picture of the disease.
Forecast and Prevention
An abscess of the abdominal cavity (ICD code 10 - K65) is a rather serious complication, so doctors and patients should take care to prevent this condition. It is necessary to adequately and fully treat inflammatory diseases of any abdominal organs, it is imperative to conduct pre- and postoperative preparation of patients, as well as to sterilize the surgeon's instruments and hands well.
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 your life and health.
Mortality from abdominal abscess reaches forty percent. It all depends on how common the process is, where it is located and what disease caused it. But with timely admission to the hospital, the likelihood of an adverse outcome is reduced.