SFGH 7.31 AM Report Pearls: Abdominal Wall Abscess

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.

http://www.nejm.org/doi/full/10.1056/NEJMoa1411162

Brook I, Frazier EH. Aerobic and anaerobic microbiology in intra-abdominal infections associated with diverticulitis. J Med Microbiol 2000; 49:827.

Lopez N, Kobayashi L, Coimbra R. A comprehensive review of abdominal infections. World J Emerg Surg. Feb 2011; 6:-7.

Evernote Link: https://www.evernote.com/shard/s300/sh/b23eb392-025e-4625-b63d-a1a756ab6bda/adc8d3cbffeb6a8d717a8949f3aa02e6

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