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Intra-abdominal abscess after penetrating abdominal trauma
R R Ivatury1, R Zubowski, P Psarras
1Department of Surgery, New York Medical College, Bronx, New York.
Abstract:
We reviewed our experience with intra-abdominal abscess after penetrating abdominal trauma. Of a total of 872 laparotomies (1980-1986), 29 patients (0.7% of stab wounds and 6% of gunshot wounds) developed abscesses. Pancreatic and duodenal injuries, in the presence of concomitant colon perforation, were most frequently associated with abscess formation. Fourteen of the 29 patients had multiorgan failure (MOF), Group I, and 15 patients did not have MOF, Group II. Group I had a significantly higher Abdominal Trauma Index (ATI) and Acute Physiology and Chronic Health Evaluation (APACHE II), received greater number of perioperative transfusions and underwent a higher number of reoperations for sepsis than Group II patients. Radiologic imaging techniques were frequently inconclusive for the diagnosis and localization of intra-abdominal abscess in Group I. They were highly accurate in Group II. Fifty per cent of Group I patients died from sepsis and MOF. We conclude that the anatomic (ATI) and the physiologic (APACHE) scores are useful predictors of the potential for uncontrolled sepsis. In the presence of ongoing multiorgan failure, reoperation for sepsis is warranted on clinical grounds alone.
Insights
Intra-abdominal abscesses following penetrating trauma are rare but serious. High injury scores predict multiorgan failure and mortality, indicating reoperation for sepsis is crucial.
Area of Science:
- Trauma Surgery
- Sepsis Management
- Surgical Critical Care
Background:
- Intra-abdominal abscesses complicate penetrating abdominal trauma.
- Risk factors and outcomes require further elucidation.
Purpose of the Study:
- To analyze the incidence, risk factors, and outcomes of intra-abdominal abscesses in patients with penetrating abdominal trauma.
- To evaluate the utility of scoring systems and imaging in predicting outcomes and guiding management.
Main Methods:
- Retrospective review of 872 laparotomies for penetrating abdominal trauma (1980-1986).
- Patients were categorized into two groups based on the presence of multiorgan failure (MOF).
- Analysis of injury severity scores (Abdominal Trauma Index and APACHE II), imaging accuracy, and treatment outcomes.
Main Results:
- 29 patients (3.3%) developed intra-abdominal abscesses.
- Pancreatic, duodenal, and colon injuries were associated with abscess formation.
- Patients with MOF (Group I) had higher injury scores, required more transfusions and reoperations, and had higher mortality.
- Radiologic imaging was less accurate in diagnosing abscesses in patients with MOF.
Conclusions:
- Anatomic (ATI) and physiologic (APACHE II) scores predict uncontrolled sepsis risk.
- Reoperation for sepsis is indicated in patients with MOF based on clinical assessment alone.
- Early recognition and aggressive management are vital for improving outcomes in these complex cases.