introduction

Of all abscesses, intra-abdominal abscesses, i.e. abscesses that form in the abdomen, are among the most common. A distinction is made depending on the location of the abscess cavity subphrenic Abscesses that lie just below the diaphragm, from subhepatic Abscesses found just below the liver. Furthermore, one differentiates so-called Loop abscessesthat form in the small intestine.

Abscesses that are right next to the colon would be called paracolic or retrocolic (if they are behind the colon). Basically, any organ in the abdomen can also form an abscess. So you can often find liver, spleen and pancreatic abscesses.

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For more information on abscess on the abdomen, see the main article Abscess.

Is an abscess on the abdomen dangerous?

An abscess is by definition an encapsulated collection of pus. As long as the pus in this capsule is literally "encapsulated" from its surroundings, it is no longer dangerous. Unless the boil depresses vital structures such as the large abdominal vessels.
However, if there is an abscess in the abdomen, there is a risk that it will burst and the pus will freely enter the abdomen and the pathogens with the pus. This can lead to an inflammatory reaction in the abdomen with subsequent peritonitis (Peritonitis) come. In the worst case, the pathogens enter the blood and lead to "blood poisoning" (sepsis).

The cause of an abscess on the abdomen

In many cases, intra-abdominal abscesses are caused by late complications after surgery. In addition to air, bacteria (despite the sterile environment) can get into the surgical field wherever cutting, sewing or injecting is carried out.

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If the bacteria settle in soft tissue, fluid can form. Furthermore, due to increased granulocyte immigration due to the increased number of bacteria at this point, pus can form, which then fills an abscess cavity. However, abscesses can also lead to adhesions after their formation and then to complaints (e.g. an intestinal twist).

Symptoms of an abdominal abscess

In many cases, especially with large abscesses, the increased immune reaction leads to a deterioration in general condition with chills and fever.

The difficulty lies in finding the cause of the deterioration in general condition in a previously unknown abscess formation. Especially after operations with the following development of fever, in addition to wound infection, abscess formation must always be considered.

Abscesses can also recur, so it is recommended to prevent abscesses in everyday life. You can find out how to prevent abscesses here: What is the best way to prevent an abscess?

Diagnosing an abscess on the abdomen

Initially, the type of inflammation is usually detected by a blood test. An increased CRP and leukocyte value, but also an increased procalcitonin value, suggest a bacterial occurrence. Sometimes the patients also report pain at the location of the abscess. An ultrasound can reveal an abscess. If the area is so covered or if the abscess focus is so small that it cannot be seen with an ultrasound, computed tomography can provide a diagnosis.

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Treatment of the abscess on the abdomen

In the case of larger abscesses or if the patient's general condition is poor, treatment is usually carried out surgically. Depending on where the abscess is located, the abscess membrane is usually split with a knife and the fluid in the abscess cavity drained or sucked off. This is followed by sterile wound irrigation and finally the closure.

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Each abscess can form again in the same place and may have to be surgically repaired again. After the operation, an antibiotic is usually given to the patient for several days. Smaller abscesses, which can usually be seen through random examinations, often do not have to be treated surgically but purely with antibiotics.

More on the subject: Surgery of an abscess.

Liver abscess

With a liver abscess, pus builds up in the liver. The pus usually arises as a result of an inflammation of the bile ducts (cholangitis) or the accumulation of bacteria via the blood into the liver.

In rare cases, the liver abscess can also be caused by fungi or amoeba. The symptoms of liver abscess are relatively non-specific. Right-sided upper abdominal pain and fever can occur. In addition, those affected can feel very weak. In order to establish a diagnosis, a blood sample should be taken, in which the inflammation parameters and liver values ​​are examined. In addition, the blood should be examined for bacteria (blood culture). An ultrasound scan of the liver may show a liver abscess.

If the ultrasound examination does not provide a clear finding, a CT examination should be carried out. Therapeutically, antibiotic therapy should be ordered and removal of the abscess should be sought. To remove the abscess, a drain is first placed through the skin into the abscess. The drainage is inserted using CT. If the therapy with drainage is unsuccessful or not possible, the abscess must be surgically removed.

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Read everything about the topic: liver abscess here

Splenic abscess

A spleen abscess is also known as an intralienal abscess. Spleen abscesses are generally very rare. It is an accumulation of pus in the spleen, which in most cases is caused by a systemic infection (sepsis).

Most often, inflammation of the heart valves (endocarditis) causes this systemic infection, which then triggers the spleen abscess. The inflammation can be caused by bacteria or fungi. Sometimes pus accumulates after a splenic infarction (spleen tissue is no longer adequately supplied with blood and dies) or after an injury to the spleen.

It is important that a spleen abscess is recognized, as the abscess can cause tissue swelling and thus the capsule that surrounds the spleen to tear. Since the spleen is well supplied with blood, the capsule rupture can lead to life-threatening bleeding.

In addition to fever and fatigue, there is typically left upper abdominal pain. A blood and ultrasound examination is carried out diagnostically. If the ultrasound does not provide any information, CT or MRT imaging can help. Therapy includes antibiotic therapy as well as abscess removal using a drainage insert over the skin or surgery.

Find out more about the topic: Splenic abscess

Kidney abscess

A kidney abscess, also called perinephritic abscess, is a collection of pus between kidney tissue and the connective tissue covering the kidney (gerota fascia). A kidney abscess can result from a kidney inflammation or it can be triggered by a tumor.

The kidney tissue affected by cancer cells disintegrates and becomes infected. Patients in intensive care, on dialysis therapy for kidney failure, weakened immune systems, or valvular heart disease are at increased risk of staphylococcal kidney abscess.

People who abuse intravenous drugs are also at increased risk of kidney abscesses. A kidney abscess is noticeable in addition to symptoms such as fever, chills and fatigue from side pain that can radiate to the stomach or back.

In addition, there may be a palpable lump under the skin. The skin can also be reddened at this point. In addition to a medical history and physical examination, a blood test is carried out diagnostically. Inflammation values ​​such as CRP or procalcitonin are examined. In addition, the kidney values ​​should be monitored in order to detect any impairment of kidney function at an early stage.
The urine should also be checked for bacteria. An ultrasound or CT scan can visualize the abscess. In addition to antibiotic therapy, it is important to remove the abscess. First, a drain is placed over the skin. If this is unsuccessful, surgical removal is necessary.

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Read here on the topic: kidney abscess

When the abscess has burst

An abscess in the abdomen is an encapsulated collection of pus.
The material contained in the abscess contains not only cells of the human immune system, dead cells and remnants of dead tissue but also a high concentration of bacteria.

If the abscess bursts, the pathogens are distributed in the abdomen and sometimes life-threatening inflammation of the peritoneum.
The peritoneum is a smooth layer that encloses the organs within the abdominal cavity.
In the case of peritonitis, severe abdominal pain, a weakening of the intestinal activity and strong tension in the abdominal wall muscles when touched.

The general condition of the patient can deteriorate rapidly, breathing and circulation can be increasingly impaired.
If peritonitis is not treated in time, there is a risk of bacteria entering the bloodstream. The result is blood poisoning.

If an abscess bursts in the abdomen, an operation must be performed under general anesthesia.
Pus and secretions are sucked off through an incision in the abdominal wall, and remnants of the abscess cavity are tracked down and cleaned up.
The abdominal cavity is rinsed several times, with the rinsing liquid usually mixed with antibiotics or germicidal substances.
Drainage tubes are placed and left in place for a few days in order to drain off any wound exudate after the operation.

The prognosis depends on the extent of the disease. The earlier the treatment is started, the better it turns out, so that at the first signs of a burst abscess in the abdominal cavity, an intensive care procedure is in the foreground.

An abdominal abscess in pregnancy

There are many special features of pregnant women that must be taken into account in the diagnosis and treatment of abscesses in the abdominal cavity.

In principle, both the health of the pregnant woman and that of the unborn child are exposed to serious dangers.

The first difficulties arise as soon as an abscess is detected in the abdomen.
In many cases, symptoms typical of pregnancy mask the symptoms of the actual illness and make it difficult to take anamnesis and perform a physical examination.

Laboratory diagnostics are also problematic.
An abscess in the abdomen is usually caused by a bacterial infection that is caused by an increase in the number of white blood cells (Leukocytes) is noticeable in the blood.
In the course of pregnancy, however, this value is also increased in healthy women, which is why the informative value of a corresponding laboratory test decreases.

The pregnant woman is also the Concentration of Stress hormones Blood (glucocorticoids) increased. These substances can in case of infection the protective one reaction of the surrounding tissue suppress and help relieve pain symptoms. Therefore, during pregnancy there may be an abscess in the abdomen is only noticed very late by the person concerned.
In the case of infections in the abdomen, the strong abdominal wall muscles usually react with severe tension. The doctor can say so about Testing of muscle tension Received evidence of serious illness. At Pregnant women however is the The degree of tension in the abdominal wall muscles is reduced from the outset and an infection that spreads in the abdominal cavity does not have to be accompanied by a tight abdominal wall.

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In the therapy it is important to remember that every surgical procedure can induce labor. Depending on the maturity of the unborn child, the doctor must decide whether to have a Tocolysis (Inhibition of labor) or one Childbirth means Caesarean section is appropriate.
An abscess in the abdomen may require antibiotic treatment. There is one here careful selection to take antibiotics so as not to harm the child's health.
The so-called tetracyclines are allowed during the entire pregnancy not used become. Metronidazole, which is otherwise often used for bacterial infections in the abdomen, should be used in the first trimester not used become.
The Prognosis for the child depends on that Maturity and from the occurrence of any Complications from. If you have an abscess in your stomach, The pathogen passes into the blood or to one Undersupply of the Mother cake, the life of the unborn child is seriously endangered.
Among the abscess diseases in pregnancy is the so-called perityphlitic abscess worth mentioning. This is a encapsulated collection of puswhich can form in appendicitis based on a perforated appendix.In women, this abscess can sink into the Douglas space, a pocket-shaped cavity between the rectum and the uterus, which in the female organism represents the lowest point of the abdominal cavity.


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