Intestinal abscess is a purulent lesion of the intestinal wall, which is a consequence of the transition of the purulent-inflammatory process from nearby organs or lymphogenic or hematogenic spread of infection from other foci. The disease can occur with rapidly developing symptoms, hyperthermia, severe pain syndrome against the background of a severe general condition or in a recurrent form. The basis of the diagnosis is the characteristic clinical picture, the results of ultrasound examination, CT data. The treatment of the disease is surgical, performed against the background of massive antibacterial therapy.
K65.0 Acute peritonitis
Intestinal abscess is a limited focus of purulent inflammation in the intestinal wall. In general surgery, this pathology is considered as a form of purulent-inflammatory processes in the abdominal cavity, the transition of the purulent process from neighboring organs or as a complication of surgical interventions. Anatomical and physiological features of the abdominal cavity, including the properties of the peritoneum, the topography of organs cause the formation of a limited inflammatory focus in the intestine.
Causes of intestinal abscess
The main etiological factor in the development of intestinal abscess is E. coli – in more than half of cases, Staphylococcus can also be the causative agent – 9-11%, streptococcus – 7-10%, Pseudomonas aeruginosa – 7-8%, proteus – 5-8%, up to 25% – anaerobic flora. The causes of the development of an abscess are considered:
- The spread of infection. Pathology occurs as a result of a direct (contact) transition of the infectious process from adjacent areas, as a result of perforation, penetration of a duodenal ulcer or another part of the intestine, destructive appendicitis, peritonitis.
- Postoperative complications. An abscess may be the result of insufficiently effective drainage, incomplete removal of effusion or damaged tissues, suppuration of postoperative hematoma; it may form along the course of the wound canal, around foreign bodies (including drains).
- Remote foci. In some cases, an abscess in the intestine can form as a result of hematogenic (with blood flow) or lymphogenic (with lymph flow) infection even from distant purulent foci, for example, with angina, osteomyelitis, furunculosis.
In 8% of cases, it is not possible to determine the specific cause of the development of an intestinal abscess.
Limited purulent inflammation in the area of intestinal abscess can be organized in several ways: the formation of a focus at the site of an infectious agent, suppuration of infected exudate, accumulation of blood or bile in the area of surgical intervention, as well as the restriction of the pathological process passing from neighboring organs, including peritonitis.
Symptoms of intestinal abscess
The clinical picture at the initial stages is determined by the underlying disease: cholecystitis, peptic ulcer, appendicitis, abdominal trauma or others. When the main pathology is complicated by an intestinal abscess, characteristic symptoms develop: a sharp intense increase in body temperature, a significant deterioration in the general condition of the patient, chills, severe pain in the abdominal cavity (its localization depends on the place of formation of the abscess).
There are three variants of the course of the disease. In most cases, the process begins violently, with hyperthermia, severe pain syndrome, the general condition of the patient is severe. This course is determined by the rapid increase of infiltration in the abdominal cavity. With a sluggish infiltration, the course of the disease is characterized by the rapid development of fever with a gradual increase in the intensity of the pain syndrome.
A recurrent course is possible, in which, against the background of a decrease in infiltration, clinical signs subside, the pain syndrome becomes less pronounced, but with the formation of a limited purulent focus inside the decreased infiltrate, the symptoms increase sharply.
If an abscess forms in the postoperative period (as a complication of surgical intervention), the development of the disease can go in two ways. In the first case, after the operation, the patient’s well-being improves, the temperature normalizes, and after the formation of a purulent focus, the characteristic symptoms increase. In the second case, the temperature after surgical treatment does not normalize and persists until the opening of the abscess.
The abscess can independently break into the intestinal lumen, while the patient’s condition improves dramatically. In the case of opening an abscess into the abdominal cavity, foci of closed purulent inflammation, spilled peritonitis may form.
Intestinal abscess has a clinical picture similar to other purulent-inflammatory diseases of the abdominal cavity, which makes it difficult to diagnose. The basis for the assumption of the development of an intestinal abscess is the characteristic symptoms in combination with anamnesis data indicating a possible source of infection or surgical intervention.
It is necessary to differentiate this disease from abdominal abscesses of other localizations: interstitial abscess, subdiaphragmatic abscess, Douglas space abscess, and other intra-organ abscesses. The following techniques are used to diagnose and distinguish with other pathologies:
- External inspection. During an objective examination of the patient, the doctor determines the tension of the abdominal wall muscles, abdominal distension, sharp soreness during palpation in the area corresponding to the localization of the abscess. Laboratory signs of this pathology are a sharp leukocytosis with a shift of the formula to the left, accelerated ESR.
- X-ray examinations. Radiography of the abdominal cavity makes it possible to visualize the formation with a fluid level (a characteristic sign of abscesses). During radiography with contrast of the intestine, a change in its internal contour in the area of the abscess is determined.
- Sonography. Ultrasound of the abdominal cavity organs in the area of localization of the abscess determines an echonegative formation with a capsule and heterogeneous liquid contents.
- Other visualization methods. If the diagnosis is difficult when using the described methods, computed tomography, magnetic resonance imaging, MSCT of the abdominal cavity is performed.
- Laboratory tests. Laboratory signs of this pathology are a sharp leukocytosis with a shift of the formula to the left, accelerated ESR.
Treatment of intestinal abscess
The basis for the treatment of intestinal abscesses is surgical removal of the abscess in combination with massive antibiotic therapy. Antibiotics are prescribed from the groups of cephalosporins, aminoglycosides, fluoroquinolones, effective against aerobic, anaerobic flora. Surgical treatment consists in opening the focus of purulent inflammation, its sanitation, drainage. Laparotomic access is used, the localization of which is determined by the location of the abscess.
If the localization of the purulent focus is not clearly defined or diagnostic difficulties have arisen, a median laparotomy is performed, allowing the surgeon to gain access to all parts of the intestine. If the end parts of the intestine are affected, surgery through transrectal access is possible. Necessarily, the focus of purulent inflammation is drained for subsequent aspiration of the discharge and washing.
Prognosis and prevention
With timely diagnosis, adequate surgical treatment, good drainage of the focus, the appointment of antibiotics that are highly effective against the pathogen, the prognosis of intestinal abscess is favorable. The prognosis is worsened by multiple abscesses, complications in the form of peritonitis, sepsis.
Prevention of pathology consists in timely treatment of patients for qualified help, adequate treatment of diseases that can cause an abscess, high-quality revision of the abdominal cavity during surgical interventions, proper management of patients in the postoperative period.