When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Intra-abdominal abscess

Last reviewed: 17 Nov 2024
Last updated: 09 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • recent history of surgery, trauma, or intra-abdominal infection
  • fever or hypothermia
  • abdominal pain
  • rectal tenderness and fullness
Full details

Other diagnostic factors

  • tachycardia
  • change in bowel habits/abnormal bowel function
  • prolonged ileus
  • anorexia/lack of appetite
  • nausea and vomiting
  • palpable mass
  • signs of sepsis
  • preoperative corticosteroid use
Full details

Risk factors

  • recent surgery or trauma, appendicitis, diverticulitis, or perforated ulcer
Full details

Diagnostic tests

1st tests to order

  • WBC count
  • drainage culture
  • abdominal CT scan
Full details

Tests to consider

  • serum CRP
  • serum erythrocyte sedimentation rate (ESR)
  • Gram stain of abscess fluid
  • serum glucose
  • abdominal ultrasound
  • abdominal MRI scan
Full details

Emerging tests

  • endoscopic ultrasound

Treatment algorithm

ACUTE

community-acquired intra-abdominal abscess: non-high risk, mild-to-moderate severity

community-acquired intra-abdominal abscess: high risk or high severity

health care-associated intra-abdominal abscess

Contributors

Authors

Laura Kreiner, MD, FACS

Assistant Professor of Surgery

MetroHealth Medical Center

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

LK declares that she has no competing interests.

Acknowledgements

Dr Laura Kreiner would like to gratefully acknowledge Dr Ali F. Mallat, Dr Lena M. Napolitano, and Dr Lillian Kao, previous contributors to this topic.

Disclosures

AFM declares that he has no competing interests. LMN has been a member of the speakers' bureau and consultant for Merck, Pfizer, Schering-Plough, Ortho-McNeil, Wyeth, and Astellas Pharma. LK declares that she has no competing interests.

Peer reviewers

James T. Lee, MD, PhD, FACS, FIDSA, FSHEA

Professor of Surgery (retired)

University of Minnesota

Saint Paul

MN

Disclosures

JTL declares that he has no competing interests.

Jeffrey A. Claridge, MD, MS, FACS

Director of Research

Division of Trauma, Burns and Critical Care

Assistant Professor

Department of Surgery

MetroHealth Medical Center

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

JAC declares that he has no competing interests.

Matthew Falagas, MD, MSc, DSc

Director

Alfa Institute of Biomedical Sciences

Marousi

Athens

Greece

Disclosures

MF declares that he has no competing interests.

  • Intra-abdominal abscess images
  • Differentials

    • Loculated intra-abdominal hematoma
    • Pancreatic pseudocyst
    • Diverticular or appendiceal phlegmon
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: radiologic management of infected fluid collections
    • The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections
    More Guidelines
  • Patient information

    Appendicitis

    Crohn disease: what is it?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer