[The pathophysiology and treatment of severe intra-abdominal abscess]

Formation of an abscess within the peritoneal cavity is a dynamic process, representing the body's success at localizing the contamination but its ultimate failure to completely destroy the bacteria and neutralize their toxic products. In most instances, the origin of the microbial insult is from bacteria which colonize the intestinal lumen. The therapeutic means are prompt surgical drainage and appropriately administered antimicrobial agents. Surgical drainage of abscess are accompanied by either (1) an extraperitoneal approach, (2) an intra-abdominal exploration, or (3) ultrasound-guided needle aspiration of the abscess. Choice of antimicrobial agents is frequently based upon prediction of pathogens from normal flora of bowel contents contaminating a normally sterile area, or from knowledge of pathogens expected in certain conditions, rather than on results of cultures and susceptibility tests. This selection frequently calls for the choice of agents effective against multiple organisms. Patients with prolonged septic courses die from a combination of the infection itself and the malnutrition resulting from the associated hypercatabolism and starvation. Nutritional therapy also of clinical importance in halting the progression toward a fatal outcome.