The 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. In medical slang, this is called "soldering", that is, the formation of adhesions between adjacent organs in such a way that a closed space is obtained.
Definition
Abscess of the abdominal cavity is a purulent inflammation of an organ or part of it, with further melting of the tissues, the formation of a cavity and a capsule around it. It can form absolutely in any "floor" of the abdominal cavity and be accompanied by symptoms of intoxication, fever and sepsis.
Besides this, the patient will experience pain, defence of the abdominal muscles, nausea and vomiting are possible. Sometimes, in difficult cases, adhesions cause intestinal obstruction.
Epidemiology
Abscess of the abdominal cavity, which is not surprising, is formed after surgical interventions and is treated as a complication of this type of treatment. Due to the growth in the number of annualoperations, the number of such complications is also progressively increasing. A large role in this is played by a decrease in immunity and the widespread use of antibiotics, which forms resistance in microorganisms and complicates postoperative prevention of complications.
According to the conclusions of the extras, one percent of surgical patients develop a postoperative abscess. This figure is higher if the intervention was an emergency and there was no time for preoperative preparation.
Risk factors
The main risk factor that can cause an abdominal abscess is, of course, abdominal surgery. Most often, it occurs after the treatment of diseases of the pancreas, gallbladder, stitching intestinal loops.
The appearance of inflammation is associated with the ingress of intestinal contents onto the peritoneum, as well as its seeding in the operating room. It can also be caused by blunt trauma to the abdomen. At the site of compression, aseptic inflammation is formed, to which the secondary flora later joins.
In more than half of the cases, the abscess is located either behind the parietal (parietal) sheet of the peritoneum, or between its parietal and visceral sheets.
Reasons
Abscess of the abdominal cavity (ICD 10 - K65) may appear as a result of abdominal trauma, for example, prolonged compression or blows, infectious diseases of the intestinal tube (iersiteosis, salmonellosis, typhoid fever), the development of inflammatory processes inorgans or mucous membranes, as well as after perforation of a stomach or intestinal ulcer.
There are three main reasons:
- Presence of secondary peritonitis due to rupture of the appendix, failure of intestinal anastomoses after abdominal operations, necrosis of the head of the pancreas, abdominal trauma.
- Purulent pelvic inflammatory disease such as salpingitis, parametritis, pyosalpinx, tubo-ovarian abscess and others.
- Acute inflammation of the pancreas and gallbladder, ulcerative colitis.
In addition to the above, sometimes the cause of an abscess may be inflammation of the perirenal tissue, osteomyelitis of the lumbar spine, tuberculous spondylitis. Most often, staphylococci, streptococci, clostridia and ischerichia are sown in the focus of inflammation, that is, the flora that can normally be found in the intestine.
Pathogenesis
Abscess after abdominal surgery appears due to an excessive reaction of the immune system to interference in the internal environment or to the reproduction of microorganisms. The pathogen can enter the abdominal cavity with the blood or lymph flow, 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 the operation. Another factor is the organs that communicate with the external environment, such as the fallopian tubes or intestines.
It is impossible to exclude the appearance of inflammatory infiltrates after a penetrating wound of the abdominal cavity, perforation of ulcers and divergence of sutures after surgic altreatment.
The peritoneum reacts to the appearance of an irritating factor (inflammation) in a stereotypical way, namely, it produces fibrin on its surface, which glues sections of the mucosa together and thus delimits the focus from he althy 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, sudden onset fever with chills and profuse sweat.
- Drawing pains in the abdomen, which are aggravated by touch or pressure.
- Increased urination as the peritoneum tightens and this irritates the baroreceptors in the bladder wall.
- Disorders of the stool in the form of constipation.
- Nausea and vomiting at the height of fever.
Also, the patient may have a rapid heartbeat. It occurs for two reasons: high temperature and intoxication. And also a pathognomonic symptom is the tension of the muscles of the press. This is a protective reflex that prevents further injury to the inflamed area.
If the abscess is located directly under the diaphragm, then in addition to the general symptoms there will be those that indicate this feature. The first difference will be that the pain is localized in the hypochondrium, increases during inhalation and radiates toscapular region. The second difference is the change in gait. The person involuntarily begins to take care of the affected side and leans towards it to reduce muscle tension.
Complications
Abscess of the abdominal cavity (ICD 10 - K65) may remain undiagnosed if it develops against the background of other serious conditions, or the patient does not seek help. But be aware that life-threatening conditions such as sepsis and diffuse peritonitis can develop as a result of such negligent behavior.
Subdiaphragmatic abscesses can melt the diaphragm and burst into the pleural cavity, forming adhesions there. Such a scenario can even lead to lung damage. Therefore, if you have a fever or pain after an operation or injury, do not expect everything to go away on its own. In such a question, an extra check will not hurt.
Diagnosis
Postoperative abscess of the abdominal cavity in a hospital is quite easy to identify. The most informative methods are X-ray, ultrasound, CT and MRI of the chest and abdomen. In addition, women can puncture the vaginal fornix to check for purulent streaks in sloping places.
In addition, do not forget about laboratory diagnostics. In the 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 overneutrophil count.
The standard in the diagnosis of abscesses remains ultrasound of the abdominal cavity. There are clear signs that indicate the presence of an inflammatory infiltrate:
- education has clear contours and a dense capsule;
- liquid inside it;
- content is heterogeneous in structure and is divided into layers;
- there is gas above the liquid.
Abdominal abscess treatment
The main method of treating abscesses, of course, remains surgery. It is necessary to drain the abscess, rinse the cavity with an antiseptic and antibiotic solution. 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, the doctor prescribes two drugs at the same time, which 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 frequent urination. And the doctor himself should remember them and not add them to the clinical picture of the disease.
Forecast and prevention
Abscess of the abdominal cavity (ICD code 10 - K65) is a fairly serious complication, so doctors and patients shouldtake care of the prevention of this condition. It is necessary to adequately and fully treat inflammatory diseases of any abdominal organs, it is imperative to carry out pre- and postoperative preparation of patients, as well as to sterilize the surgeon's instruments and hands well.
If you suspect 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 could save your life and he alth.
The mortality rate 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.
