小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热或低体温
- 腹痛
- 炎症性肠病病史
- 直肠压痛和充盈
其他诊断因素
- 心动过速
- 排便习惯的改变/肠道功能异常
- 延发性肠梗阻
- 厌食/食欲不振
- 恶心和呕吐
- 胆道疾病史
- 可触及肿块
- 营养不良
- 出现脓毒症体征
危险因素
- 糖尿病
- 恶性肿瘤
- 近期手术或外伤、阑尾炎、憩室炎或溃疡穿孔
- 男性
- 年龄＞ 65 岁
诊断性检查
首要检查
- 白细胞计数
- 引流培养
- 腹部 CT 扫描
需考虑的检查
- 血清 CRP
- 血清红细胞沉降率 (ESR)
- 脓液革兰染色
- 血清葡萄糖
- 血清肝功能检查
- 血清白蛋白
- 腹部超声
- 腹部 MRI 扫描
- 铟标记的白细胞
新兴检查
- 超声内镜
治疗流程
社区获得性腹腔脓肿：非高危，严重程度为轻度至中度
社区获得性腹腔脓肿：高危或严重程度高
院内感染的腹腔脓肿
撰稿人
作者
Laura Kreiner, MD, FACS
Assistant Professor of Surgery
MetroHealth Medical Center
Case Western Reserve University School of Medicine
Cleveland
OH
利益声明
LK declares that she has no competing interests.
鸣谢
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.
利益声明
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.
同行评议者
James T. Lee, MD, PhD, FACS, FIDSA, FSHEA
Professor of Surgery (retired)
University of Minnesota
Saint Paul
MN
利益声明
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
利益声明
JAC declares that he has no competing interests.
Matthew Falagas, MD, MSc, DSc
Director
Alfa Institute of Biomedical Sciences
Marousi
Athens
Greece
利益声明
MF declares that he has no competing interests.
鉴别诊断
- 包裹性腹内血肿
- 胰腺假性囊肿
- 憩室或阑尾蜂窝组织炎
更多 鉴别诊断指南
- 美国放射学会标准：对感染积液所做的影像学处理
- 从全球角度管理腹腔内感染：2017 年 WSES 腹腔内感染管理指南
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