Abscesses of the abdominal cavity

Abscesses of the abdominal cavity (Douglas space, sub-diaphragmatic, intercellular spaces) are the outcome of diffuse forms of peritonitis. They are usually polymicrobial, and more often there is a combination of aerobic microbial associations (E. coli, streptococci, proteus idr.) And anaerobes (bacteroides, clostridia, fusobacteria, etc.). Intraperitoneal abscesses can be single and multiple.

Symptoms, course. Initially, the symptomatology is unclear: usually again a rise in the temperature of intermittent or hectic character, combined with chills and tachycardia. Frequent symptoms are paralytic intestinal obstruction, local muscle strain of the anterior abdominal wall, lack of appetite, nausea. The intensity of symptoms depends on the size of the abscess, its location, the intensity of antibiotic therapy. Muscle tension and pain are usually more pronounced with abscesses located in the mesogastrium (close to the anterior abdominal wall); Subdiaphragmatic abscesses give less pronounced local symptomatology. In the blood, leukocytosis is found with a shift of the formula to the left. With a review of fluoroscopy of the abdominal cavity, it is possible to detect the level of fluid in the cavity of the abscess with gas above it. Contrastive examination of the gastrointestinal tract can reveal displacement of the intestine or stomach by infiltration.

If the abscess is caused by the inconsistency of the sausage-type joints, it is possible that the contrast material enters the cavity of the abscess from the intestinal lumen. In the diagnosis of abscesses of the abdominal cavity the leading role is played by ultrasound scanning of the abdominal cavity, computer X-ray tomography. Ultrasonic examination is especially indicated when the abscess is located in the upper part of the abdominal cavity.

Treatment depends on the location of ulcers and their number.

Subdiaphragmatic abscesses arise as a result of surgical interventions on the stomach, duodenum, gall bladder and bile ducts, with rupture of liver abscesses. Left-sided abscesses are more often caused by complications after splenectomy, pancreatitis, inconsistent sutures after gastrectomy and proximal gastrectomy. Fewer rarely subdiaphragmatic abscesses, especially right-sided abscesses, are caused by accumulation of residual pus after treatment of diffuse peritonitis. In this case, the suction action of the diaphragm is important.

Symptoms, course. Pain in the hypochondrium with irradiation in the scapula or the shoulder (Kehr's symptom); The patient walks, bending to the sore side, supporting the area of ​​the hypochondrium with the hand. When palpation is determined by the rigidity of the muscles of the upper abdominal wall and tenderness along the intercostal spaces in the zone of localization of the abscess. With a forward disposition of the abscess, the pain syndrome is more pronounced. With a prolonged course, there may appear pasty and bulging of the intercostal spaces, respectively, the localization of the abscess, a pronounced soreness in this area. At X-ray examination - high standing and limitation of mobility during breathing of the dome of the diaphragm, in lung-atelectasis, pneumonic foci in the lower segments of the lung, fluid in the pleural cavity. In the abdominal cavity, it is possible to detect the level of fluid under the diaphragm, the displacement of neighboring organs by an abscess.

Treatment operative - opening and draining the abscess. When choosing an access, the precise localization of the abscess matters. With anterior subdiaphragmatic abscesses, an extraperitoneal dissection of the clitoris is performed along the course of the costal arch. They reach the transverse fascia, exfoliate it to the softening zone and open the abscess. The cavity is washed and drained with double-lumen drainage for active aspiration with washing. With posterior localization, extrapleural access is used on the bed of the XII rib after its excision.

Complications: sepsis, abscess penetration into the free abdominal or pleural cavity.