Diagnosis and treatment of intra-abdominal abscess in critically ill patients

Intra-abdominal abscess remains a challenging clinical problem. Patients are frequently critically ill with major organ system failure. An aggressive diagnostic and therapeutic approach is mandated. Application of newer imaging techniques should allow a better than 90 per cent accuracy of abscess localization. Clearer definition of the abscess cavity by ultrasound or computerized tomography facilitates planning of surgical drainage route preoperatively. Ultrasound and computerized tomography have also allowed directed percutaneous aspiration of intra-abdominal fluid collections for diagnosis. In selected patients, percutaneous drainage has the proven capability to completely resolve a large percentage of intra-abdominal abscesses. Final application of this technique awaits further study.