Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever or hypothermia
- abdominal pain
- history of inflammatory bowel disease
- rectal tenderness and fullness
Other diagnostic factors
- tachycardia
- change in bowel habits/abnormal bowel function
- prolonged ileus
- anorexia/lack of appetite
- nausea and vomiting
- history of biliary disease
- palpable mass
- malnourishment
- signs of sepsis
Risk factors
- diabetes
- malignancy
- recent surgery or trauma, appendicitis, diverticulitis, or perforated ulcer
- male sex
- age >65 years
Diagnostic investigations
Investigations to consider
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
- Gram stain of abscess fluid
- drainage culture
- serum glucose
- serum LFTs
- serum albumin
- abdominal ultrasound
- abdominal MRI scan
- indium-labelled leukocytes
Emerging tests
- fluorodeoxyglucose (FDG)-positron emission tomography (PET) and FDG-PET/CT
- endoscopic ultrasound
Treatment algorithm
Contributors
Authors
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.
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
Professor of Surgery (retired)
University of Minnesota
Saint Paul
MN
Disclosures
JTL declares that he has no competing interests.
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.
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
Disclosures
MF declares that he has no competing interests.
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