Diagnosis of postoperative intra-abdominal abscess

Clinical, laboratory, radiologic, and radionuclide findings of 40 patients with operatively proven intra-abdominal abscesses were evaluated to determine their degree of diagnostic accuracy. Correct preoperative diagnosis was established by clinical, laboratory, and simple radiologic technics in 24 (60%) patients, whereas more sophisticated imaging procedures were used in 16. Gallium citrate Ga 67 scan was done in nine and was positive in six, ultrasonic scan was positive in seven of 16, and computerized tomography in six of eight patients. In 12, two consecutive imaging procedures were used. Concordant results were obtained in eight, of which five were accurate and three inaccurate. Of the four remaining patients with discordant results, the second imaging procedure was incorrect in three and correct in one instance. Accordingly, sophisticated imaging procedures were done in only 40% of patients and were accurate in 75% of less of cases. Furthermore, addition of a second imaging procedure did not increase diagnostic accuracy. Therefore, these technics, while improving the previously existing diagnostic means, should be still considered less than perfect and their negative result should not exclude the need for diagnostic celiotomy when clinical findings are highly suggestive of intra-abdominal abscess.