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Intraperitoneal abscesses: diagnostic dilemmas and therapeutic options

P R Pai1, A N Supe, R D Bapat

  • 1Department of General Surgery, Seth G S Medical College, Bombay.

Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology
|January 1, 1995
PubMed
Summary

Early diagnosis of intraperitoneal abscesses is vital for better prognosis. Ultrasound-guided percutaneous drainage suits simple cases, while complex abscesses need operative intervention for improved outcomes.

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Area of Science:

  • Gastroenterology
  • Surgical Sciences
  • Diagnostic Imaging

Background:

  • Intraperitoneal abscesses present diagnostic challenges, often leading to treatment delays and poor patient outcomes.
  • Despite advances, optimal therapeutic strategies for these abscesses remain unclear.

Purpose of the Study:

  • To evaluate clinical features and investigations for diagnosing intraperitoneal abscesses.
  • To analyze the relationship between diagnostic delay and prognosis.
  • To assess the effectiveness of various treatment modalities.

Main Methods:

  • Analysis of 30 patients with intraperitoneal abscesses, categorized by ultrasonography (USG) findings (simple vs. complex).
  • Evaluation of clinical data, laboratory results (hematology, biochemistry, microbiology), and imaging (USG, contrast X-rays).

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  • Assessment of therapeutic interventions including percutaneous aspiration/drainage and operative drainage.

    • Main Results:

    • Clinical and hematological data were sensitive but non-specific; Klebsiella was the most common pathogen.
    • Real-time ultrasonography demonstrated 84% accuracy; contrast X-rays were needed in 43% of cases.
    • Deaths occurred in patients with delayed diagnosis (>4 days); USG-guided drainage was effective for simple abscesses, while operative drainage succeeded in complex cases.

    Conclusions:

    • Early detection and treatment are crucial for favorable prognoses in intraperitoneal abscesses.
    • High clinical suspicion combined with appropriate imaging modalities facilitates early diagnosis.
    • USG-guided percutaneous drainage is suitable for simple abscesses; complex cases necessitate operative drainage, potentially combined with initial USG-guided procedures.