abdominal abscess
Introduction
Introduction to abdominal abscess Abdominal abscess refers to a certain gap or part of the abdominal cavity due to tissue necrosis and liquefaction, entrapped by the intestines, viscera, abdominal wall, omentum or mesentery, forming a localized pus accumulation. Including underarm abscess, pelvic abscess and intestinal abscess. This disease can be caused by various diseases, abdominal surgery and trauma caused by secondary peritonitis. Infection is the main cause of abdominal abscess. basic knowledge The proportion of illness: the incidence rate is about 0.003% - 0.005%, more common in patients with blood infectious diseases Susceptible people: no special people Mode of infection: non-infectious Complications: septic shock
Cause
Cause of abdominal abscess
Abdominal organ perforation and inflammation (35%):
Underarm abscess is often secondary to perforation and inflammation of the abdominal organs, such as perforation of acute appendicitis, perforation of gastroduodenal ulcer, perforation of liver abscess often causes right submandibular abscess, and infection of the stomach, splenectomy, hemorrhagic necrosis Pancreatitis often causes left axillary abscess, most of the pathogens come from the gastrointestinal tract, often mixed infection of Escherichia coli, Streptococcus, Klebsiella and anaerobic bacteria, spread from the thoracic suppurative disease to the underarm, then Staphylococcus, streptococcus, pneumococcal infections.
Peritonitis (25%):
Peritonitis is a serious disease common to surgery caused by bacterial infections, chemical stimuli or injuries. Most of them are secondary peritonitis, which originates from abdominal organ infection, necrotic perforation and trauma. Its main clinical manifestations are abdominal pain, abdominal muscle tension, as well as nausea, vomiting, fever, severe blood pressure drop and systemic toxic reactions. If not treated promptly, it can die of toxic shock. Some patients may have pelvic abscess, intestinal abscess and underarm abscess, axillary abscess and adhesive intestinal obstruction.
Perforation of appendicitis (25%):
Inflammatory exudate or pus in the abdominal cavity tends to accumulate in the pelvis and form an abscess. The most common cause is perforation of appendicitis.
Prevention
Abdominal abscess prevention
The formation of abdominal abscess after appendectomy is related to surgical treatment errors, and the consequences are more serious. Therefore, prevention should be emphasized.
1. Localized or diffuse peritonitis caused by perforation of acute appendicitis, intraoperative suction pus, after the appendix is removed, the abdominal cavity should be routinely washed (500 ml of 0.9% sodium chloride solution plus 80,000 units of gentamicin or card) Natamycin 0.5 g), right condyle (and pelvic cavity if necessary) placed a cigarette drainage strip, after surgery should be given a large dose of antibiotics to control infection.
2. When the inflammation of the appendix is heavier and the surrounding inflammatory necrotic tissue is incompletely removed, the right condyle should be placed with a smoker drainage, and a large dose of antibiotics should be given to control the infection.
3. Inflammation and necrosis of the root and cecal wall of the appendix is serious, and the stump ligation is not reliable. When there is a possibility of fecal fistula, in addition to the drainage of the cigarette in the abdominal cavity, it is best to treat the ileocecal part and return it to the abdominal cavity after the inflammation has subsided.
Complication
Abdominal abscess complications Complications septic shock
Improper treatment can cause infection and necrosis of the whole abdomen.
Symptom
Symptoms of abdominal abscess common symptoms pulsatile mass fasting abdomen with water sounds abscess pleural effusion
Underarm abscess
Systemic symptoms: Fever is a common symptom of underarm abscess, which is characterized by persistent high fever, increased pulse, and thick and thick tongue coating. Then began to appear general weakness, weakness, night sweats, anorexia, weight loss, blood tests can be found that the number of white blood cells increased significantly, the proportion of neutrophils also increased.
Local symptoms: There may be persistent dull pain in the area where the abscess occurs, and the pain may be aggravated when breathing deeply. The location of the pain is often located under the costal margin and below the xiphoid. If the abscess is located behind the liver, pain in the kidney area may occur, and sometimes the pain may radiate to the neck and shoulders. Abscess stimulation of the diaphragm can cause hiccups. The infection under the armpit can cause pleural and lung reactions through the return of the lymphatic system, and there are discomfort such as pleural effusion, cough, chest pain. If the abscess is worn into the chest, empyema can occur. In recent years, due to the massive abuse of antibiotics, the local symptoms of abdominal abscess are mostly atypical. In severe cases, localized skin edema may occur, local skin is hot and the temperature rises. The amplitude of thoracic activity decreased when the affected side was breathing, and the intercostal space was not as obvious as the healthy side. The liver dullness is enlarged. About 25% of patients have gas in the abscess and can smash out four different acoustic zones.
Pelvic abscess
The area of the pelvic peritoneum is small, and the ability to absorb toxins is poor. Therefore, the systemic symptoms of pelvic abscess are mild and the local symptoms are relatively obvious. In the treatment of acute peritonitis, perforation of appendicitis or colon, rectal surgery, patients with normal temperature rise again, typical rectal or bladder irritation symptoms, such as urgency and heavy (consciously stool is not clean), frequent stools Less, stool mixed with mucus, frequent urination, urgency, dysuria, difficulty urinating, etc., should consider the possibility of pelvic abscess. There are no obvious symptoms in the abdomen. Rectal examination can be found in the anal sphincter relaxation, in the anterior rectal wall can be touched in the rectal cavity bulging, tender, and sometimes have a sense of fluctuation.
Inter-abdominal abscess
Patients with intestinal abscess often show symptoms of suppurative infection. Because the infected lesion is relatively closed and isolated, it causes less systemic reaction. The fever symptoms are less obvious than the above two abdominal abscesses, mostly low fever. But the symptoms and signs of the abdomen are relatively prominent. Patients often have localized abdominal pain, mostly pain, and discomfort such as abdominal distension. The body may have abdominal tenderness and can touch the abdominal mass. If the abscess enters into the intestine or bladder, it will form an internal hemorrhoid, and the pus can be ruled out with the urine. In addition, intestinal abscess can also cause mechanical intestinal obstruction, abdominal pain, bloating, vomiting, stop venting, defecation and other obstruction normal.
Examine
Examination of abdominal abscess
Upper abdominal X-ray and gastrointestinal barium examination help to determine the location of the abscess. Puncture can indeed spread inflammation along the needle. For example, puncture through the rib angle can cause chest infection, so some surgeons prefer to perform exploratory incision. We think that when the condition is serious and the diagnosis is not certain, it can be on X-ray or The B-ultrasound guides the puncture, and if the pus is taken out, the drainage is immediately cut. In fact, when the abscess is present, most of the rib angles have been adhered, so the chance of puncture caused by puncture is small.
Diagnosis
Diagnosis and diagnosis of abdominal abscess
Acute peritonitis or intra-abdominal inflammatory disease after treatment has improved, or patients with fever and abdominal pain after a few days of abdominal surgery should consider the possibility of abdominal abscess and need further examination.
Underarm abscess: Abdominal radiographs and gastrointestinal barium examinations help to determine the location of the abscess, and the shadow of the placebo can be seen under the armpit. Since 10% to 25% of the abscess contains gas, the gas-liquid level is visible. The patient took the standing position and filmed from the front and back and the lateral position. It can be seen that the lateral movement of the disease side disappeared or weakened, showing an underarm infection, but not necessarily empyema. It can also be found that the ipsilateral diaphragm is elevated and is restricted or disappeared with respiratory movement, and the rib angle is blurred and disappears. The lung field is blurred, indicating pleural reaction, reactive pleural effusion, partial atelectasis of the lower lung, and changes in lung parenchyma. When the abscess contains gas, there may be a gas-liquid level. About 10% of the underarm abscess has an infection of the gas-producing bacteria, and the gas of the stomach and the duodenum is perforated. Left underarm abscess, the fundus can be displaced due to pressure drop. B-ultrasound or CT examination has great significance for the diagnosis and differential diagnosis of underarm abscess. B-ultrasound can clearly show the size, location, depth and depth of the abscess, especially in the diagnosis of B-ultrasound, not only can help qualitative diagnosis, and for small abscess can be injected after the pus treatment. However, it should be noted that patients with negative punctures cannot rule out the possibility of abscesses.
Pelvic abscess: married women can still undergo pelvic examination through the vagina to identify a pelvic inflammatory mass or abscess. If it is a pelvic inflammatory mass or abscess, the pus can be puncture through the rectum or posterior vaginal canal after emptying the bladder, which is helpful for diagnosis. Abdominal B-ultrasound or rectal B-ultrasound can help to determine the diagnosis of abscess, the size and location of abscess, etc. If necessary, CT examination can be done to help further confirm the diagnosis.
Intestinal abscess: Abdominal X-ray examination can find the widening of the intestinal wall and local intestinal sputum B-mode ultrasound, especially the computed tomography (CT) can determine the location and extent of the abscess.
Diagnostic puncture: Puncture can indeed spread inflammation along the needle path. For example, puncture through the rib angle can cause chest infection, so some surgeons prefer to perform exploratory incision. We think that when the condition is serious and the diagnosis is not certain, Puncture under the guidance of X-ray or B-ultrasound. If the pus is taken out, the drainage is immediately cut. In fact, when the abscess is present, most of the rib angles have been adhered, so the chance of puncture caused by puncture is small.
