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Intra-abdominal abscess

Last reviewed: 30 Mar 2025
Last updated: 23 Apr 2025

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
  • abdominal ultrasound
  • abdominal MRI scan
Full details

Tests to consider

  • serum CRP
  • serum erythrocyte sedimentation rate (ESR)
  • Gram stain of abscess fluid
  • serum glucose
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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Mazuski JE, Tessier JM, May AK, et al. The Surgical Infection Society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017 Jan;18(1):1-76.Full text  Abstract

Pieracci FM, Barie PS. Intra-abdominal infections. Curr Opin Crit Care. 2007 Aug;13(4):440-9. Abstract

Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: radiologic management of infected fluid collections. 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 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
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