Last reviewed: 25 Oct 2020
Last updated: 04 Mar 2020

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
More investigations to consider

Emerging tests

  • fluorodeoxyglucose (FDG)-positron emission tomography (PET) and FDG-PET/CT
  • endoscopic ultrasound
More emerging tests

Treatment algorithm

Contributors

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 reviewersVIEW ALL

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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