Take home pearls from the case:
- Intra-abdominal infections can be classified as “uncomplicated” (intramural GI tract involvement without anatomic disruption) and “complicated” (extend beyond the source organ to the peritoneal space – abscesses count here!)
- Abdominal abscesses usually contain 4-6 type of colonic flora (just like this patient!) with B. Fragilis and E. coli being the most common dominant isolates
- The most common underlying etiologies are appendicitis, diverticulitis, colon cancer, IBD and colonic surgery.
- Percutaneous drainage is as efficacious as surgical drainage for source control if there is no known ongoing source of peritoneal contamination
- Systemic antibiotics should be given for complicated intra-abdominal infection for 1-2 weeks, and further treatment needs should be based on repeat imaging
- ***Updated info (thanks to Brad and Ali Khaki for being so up to date with the literature!) – A recent NEJM article showed that, after source control, a short course of about 4 days of antibiotics resulted in similar outcomes with a longer course of about 8 day (link to the article below)***
- Remember to do a bi-manual pelvic exam (you can skip the speculum!) and check obturator and psoas signs if abdominal abscess is on your differential!
***Sawyer, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. New Engl J Med 2015; 372:1996-2005.
Lopez N, Kobayashi L, Coimbra R. A comprehensive review of abdominal infections. World J Emerg Surg. Feb 2011; 6:-7.