Intra-abdominal abscess unassociated with prior operation

T. C. Field and J. Pickleman

During the past five years, 65 patients were treated for intra-abdominal abscesses unassociated with prior operation. Radiologic tests proved quite accurate in confirming the diagnosis. Abdominal x-ray films were abnormal in 25 (57%) of 44 patients, as were ultrasonograms in 33 (89%) of 37 patients, computed tomography scans in 13 (100%) of 13 patients, and gallium scans in five (100%) of five patients. Celiotomy was performed in each patient with both abscess drainage and the appropriate management of the diseased organ. Seven patients (10.8%) died, and in five death was due to uncontrolled sepsis. Duration of hospitalization averaged 23 days (seven days preoperatively and 16 days postoperatively). Twenty-two (34%) of 65 patients had an incorrect preoperative diagnosis leading to prolonged antibiotic treatment and delay in operation. The mortality was significant in seven (10.8%) of 65 patients, unrelated to the type of operative drainage (Penrose v sump) but clearly related to uncontrolled intra-abdominal sepsis. A heightened suspicion of this problem should allow for an earlier diagnosis and an improved outcome. Prompt abdominal reexploration is indicated in those patients manifesting continued evidence of sepsis or organ failure.