Abdominal abscess. A surgical strategy
P. L. Glick, C. A. Pellegrini, S. Stein and L. W. Way
To reassess the role of laparotomy and extraserosal drainage in the
treatment of patients with abdominal abscess, we analyzed the course of 79
patients who underwent 97 operations to treat 120 abdominal abscesses
during a five-year period. In 66 clinical episodes the abscess was drained
by the most direct approach. Sepsis resolved with a single operation In 80%
of these patients, five patients (8%) required a second operation for
drainage for an abscess, and eight patients (12%) died. In 31 clinical
episodes, the abscess was drained by a laparotomy. Sepsis resolved with a
single operation in 61% of these patients, seven patients (21%) had a
second abscess, six patients (19%) required a second operation to drain a
metachronous abscess, and six patients (19%) died. When the location or
number of abscesses was diagnosed incorrectly, the success rate of therapy
fell substantially. Since most abdominal abscesses can now be accurately
diagnosed preoperatively, most abscesses should be drained by a direct
approach. Exploratory laparotomy is indicated when preoperative
localization is unsuccessful, when sepsis has not resolved after other
methods of drainage, or when the patient has a concomitant abdominal
condition that must be treated surgically.