Introduction
Intraabdominal abscesses represent a critical clinical condition characterized by the localized collection of cellular debris, enzymes, and microorganisms encapsulated within a pseudo capsule that forms part of the host's immune response to infection, inflammation, trauma, or malignancy. These abscesses can arise from various etiologies, including gastrointestinal perforation, postoperative complications, trauma, or infection spreading from adjacent organs such as the appendix, pancreas, or biliary system. Intraabdominal infections may precede abscess formation, originate from inflammatory or infectious infiltration of abdominal organs, or spread through direct contact, bloodstream, or lymphatics.
Intraabdominal abscesses are often polymicrobial, involving bacteria, fungi, and sometimes parasitic organisms, though aseptic collections also occur. An intraabdominal abscess can impact systemic functioning, delay recovery, cause additional complications, and should be considered with any adverse postoperative changes or slow progress.[1] The condition can remain localized or progress to peritonitis, signifying significant clinical dysfunction.[2] The pathophysiology of abscess formation includes the interplay of host immune defenses and the hypoxic, acidotic microenvironment within the abscess, which limits antibiotic efficacy and complicates treatment.[3] Additionally, abscesses are frequently walled off by omentum, mesentery, or other intraabdominal structures, further hindering therapeutic penetration.
Prompt diagnosis and management of intraabdominal abscesses are essential to prevent high morbidity and mortality. If left untreated, these abscesses can lead to systemic dysfunction, delayed recovery, and severe complications, including sepsis and multiorgan failure. Advances in imaging modalities and minimally invasive drainage techniques have improved the ability to diagnose and effectively treat this condition. However, optimal outcomes require a multidisciplinary approach considering abscess location, microbial etiology, patient comorbidities, and resistance patterns. Generally, perforation of the upper gastrointestinal tract is associated with less morbidity and mortality than leaks from a colonic perforation or injury; however, any condition giving rise to an abscess must be promptly diagnosed and treated to avoid high morbidity and mortality.[4][5][6]
This review provides a comprehensive overview of abdominal abscesses, addressing their pathophysiology, clinical manifestations, diagnostic strategies, and management options. Special attention is given to the role of interventional radiology, surgical approaches, antimicrobial therapy, and emerging trends and treatment challenges. By synthesizing current evidence to manage this complex and potentially life-threatening condition, this course aims to inform clinical practice and improve patient outcomes.
Etiology
Register For Free And Read The Full Article
Search engine and full access to all medical articles
10 free questions in your specialty
Free CME/CE Activities
Free daily question in your email
Save favorite articles to your dashboard
Emails offering discounts
Learn more about a Subscription to StatPearls Point-of-Care
Etiology
The causes for an intraabdominal abscess can be broadly categorized into inflammatory, infectious, malignant, traumatic, and iatrogenic. This condition can arise de-novo in the abdominal compartment, derive from an intraabdominal structure, or be disseminated from extraabdominal sources. While there are case reports detailing an intraabdominal abscess from various sources, most intraabdominal abscesses contain colonic flora. Microbe speciation depends on geographical location and the affected person's overall health.[7]
Sources for an intraabdominal abscess include but are not limited to diverticulitis, perforated ulcer, appendicitis, gangrenous cholecystitis, bowel infarction, splenic infarct or infection, inflammatory bowel disease, trauma, anastomotic leak, and intraoperative contamination.[8] Systemic infectious agents can give rise to an abscess, including rare cases of echinococcosis or amebiasis, in adults and the pediatric population.[9][10][11] Periodontal disease is an important potential source for bacterial dissemination that may give rise to an abscess.[12] Foreign bodies such as peritoneal dialysis catheters or rare retained objects may also result in an intraabdominal abscess.[13][14] A splenic abscess as a consequence of endocarditis is rare but conveys significant clinical consequences.[15] Persons with Crohn disease may form spontaneous abscesses, and there are cases of familial adenomatous polyposis associated with desmoid tumors complicated by abscesses.[16][17][18] Dropped gallstones causing postoperative abscesses have been reported.[19] Rarely an appendicolith can lead to a postoperative abscess.[20] Uncommon causes include the case report of an inflammatory left lower quadrant abscess from a colonic mucosa-associated lymphoid tissue lymphoma in a man aged 68.[21] Further, an intraabdominal process may rarely create distant abscesses, as in the case of a diverticular sigmoid perforation localizing to an abscess in the left inguinal region.[22]
Colonic flora is commonly found within intraabdominal abscesses, and predominant organisms include Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter, Streptococci, Enterococci, Neisserium, and a spectrum of anaerobic bacteria including Bacteroides, Clostridium, and Chlamydia trachomatis.[23][24][25][26][27] Coliform bacteria often contribute to early stages and anaerobes to later sequelae of abscess formation.[28] Candida species have been reported in infections originating from the gastrointestinal tract, particularly in those taking precedent antibiotics with a history of recurrent infection or being immunocompromised.[29][30] Intraabdominal infections in hospital settings contain nosocomial pathogens, including Pseudomonas aeruginosa and other organisms prone to drug resistance.[31][32]
Postoperative abscess is a common occurrence. There is an estimation that approximately 70% of intraabdominal abscesses are postsurgical, with around 6% of patients undergoing colorectal surgery developing a postoperative abscess. Hepatic abscesses account for 13% of all intraabdominal abscesses. Most hepatic abscesses involve the right lobe, likely due to the larger size and greater blood supply.[33] Prediction models have been created to anticipate risk factors for postoperative complications.[34][35] Results from a study of individuals who underwent pancreaticoduodenectomy and had bile sampling performed intraoperatively after transection of the common bile duct found that of the 539 persons included, over 80% had a positive bile culture, and these patients had a higher incidence of intraabdominal abscess compared to those without bile contamination.[36] Results from another study found C-reactive protein (CRP) level on postoperative day 3 to be an independent predictor of abscess following distal pancreatectomy. Abscess following appendectomy was associated with elevated CRP and perforation as per the results from a study on 423 persons who underwent laparoscopic appendectomy.[37]
There are cases of sterile abscess collections. Transabdominal injections occasionally result in the formation of a sterile intraabdominal abscess.[38] Aseptic abscess syndrome is a rare but known complication in those with inflammatory bowel disease and occasionally may be the first indicator of the diagnosis. Cultures of the abscess are sterile. Most cases are initially misdiagnosed and treated with antibiotics to which the patient does not respond, but the collections respond well to immunosuppressive therapy. A report from the British Medical Journal documents the case of a 43-year-old woman with Crohn disease who developed multiple abscesses through her abdominal cavity and lungs and was ultimately diagnosed with aseptic abscess syndrome, successfully treated with high-dose intravenous steroids.[39]
Intraabdominal sources of infection may migrate to extraabdominal locations. A case series of 3 colorectal perforations presenting as thigh abscesses has been published. These cases involved colectomies for malignancy, and the diagnosis of perforation was delayed with ensuing high morbidity and mortality.[40] A tubo ovarian abscess, which can occur in young, nonsexually active persons as well as adults, can have significant clinical consequences with high morbidity and can arise from a gynecologic but also a gastrointestinal source.[41][42]
Epidemiology
Intraabdominal abscesses are relatively common and have significant implications for patient morbidity and mortality. Over 60% of these abscesses are hospital-acquired, highlighting the substantial contribution of healthcare-associated infections to their prevalence. Hospital-acquired abscesses are more likely to be associated with severe complications, including sepsis and multiorgan failure, often necessitating intensive care. Delays in diagnosis, antimicrobial resistance, and coexisting conditions markedly increase mortality rates in these patients.
Appendicitis and diverticulitis are among the most frequent etiologies of intraabdominal abscesses, posing the greatest risks.[7] In a study of 243 cases, results showed that appendicitis accounted for most infections, followed by diverticulitis. Polymicrobial infections were prevalent, identified in 81.9% of cases. The study isolated 428 microorganisms, including 412 bacteria and 16 Candida species. Among these, Escherichia coli and Bacteroides fragilis were the most commonly identified pathogens in community-acquired infections, while hospital-acquired cases showed a higher prevalence of Enterococcus faecium. The bacterial distribution also varied by anatomical location; E coli and B fragilis predominated in submesocolic abscesses, whereas Candida species were more frequent in supramesocolic infections. Resistance to antibiotics such as cefotaxime-metronidazole was more pronounced in hospital-acquired infections, likely due to the higher proportion of enterococci in these settings.[7]
Pediatric cases offer distinct epidemiological insights. Results from a study of 66 children with intraabdominal abscesses revealed that over 80% of these children presented with leukocytosis and elevated CRP levels, underscoring the importance of these markers in the pediatric population. The most common pathogens were E coli and B fragilis, with specific organisms varying by infection site. For instance, E coli was frequently isolated from renal sources, while Streptococcus viridans were predominant in hepatic abscesses.[43] Nonsexually active adolescents with tubo ovarian abscesses often demonstrated anaerobic gut flora as the primary cause.[41] Risk factors and immune responses may differ in specialized populations. Results from a study examining inflammatory cytokines in individuals with type 2 diabetes found significant differences in interleukin (IL)-8 and IL-10 levels between those with and without intraabdominal abscesses, suggesting that biochemical markers of infection vary based on underlying health conditions.[44]
Pathophysiology
Intrabdominal abscesses result from a complex interaction between infection, inflammation, and the body’s attempt to localize the insult; they may be focal or widespread within the peritoneal cavity and often arise following gastrointestinal perforation, trauma, or surgery. Postoperative fluid collections, for instance, are typically organized over 5 to 7 days into encapsulated abscesses. These localized purulent collections are walled off by adhesions involving the omentum or nearby viscera, serving as a containment strategy by the host immune system.
The formation of an abscess begins with the invasion of pathogens, often polymicrobial, including aerobic and anaerobic bacteria such as E coli and B fragilis. Pathogens trigger an inflammatory cascade involving neutrophils, macrophages, and cytokines such as tumor necrosis factor-alpha (TNF-α), IL-1, and IL-6. These immune responses create a hypertonic microenvironment that expands the abscess cavity. For example, the polysaccharide capsule of B fragilis enhances its virulence by enabling its survival and proliferation within the anaerobic and acidic milieu of the abscess.[3]
Anaerobic metabolism within the abscess cavity contributes to tissue hypoxemia, diminished oxygen diffusion across capillary membranes, and increases in lactate, which is associated with increased mortality.[45] These conditions impair oxygen diffusion and create conditions resistant to antibiotic therapy and immune clearance. This environment not only sustains the abscess but also increases the risk of systemic complications such as sepsis if left untreated.[8][46][47] The encapsulating pseudo-capsule, primarily composed of fibrin and collagen, limits pathogen dissemination but also inhibits antibiotic penetration and neutrophil function, making the abscess a protected niche for microbial survival. In cases of Crohn disease, the proinflammatory state leads to stricturing, fibrostenosis, and the potential for perforation, which can cause abscess formation and fistulization between structures such as the bowel, bladder, and abdominal wall.[3] Similarly, aseptic abscess syndrome, often associated with inflammatory bowel disease, features sterile neutrophilic infiltrates and granulomatous reactions surrounding the collections, distinguishing it from infectious abscesses.
Without treatment, abscesses can expand due to ongoing inflammation, anaerobic bacterial activity, and the hypertonic environment. This can lead to further complications, including peritonitis and systemic sepsis, which significantly increase morbidity and mortality. Aseptic abscess syndrome, while not infectious, shares a similar immune-mediated inflammatory basis and is often characterized by granulomatous reactions distinct from other neutrophilic conditions such as pyoderma gangrenosum.[39]
History and Physical
History
A thorough history is critical in evaluating a patient suspected of having an intraabdominal abscess. Patients often present with nonspecific symptoms such as fever, malaise, fatigue, and localized or diffuse abdominal pain, typically dull, persistent, and exacerbated by movement or deep inspiration. Nausea, vomiting, and anorexia are common, particularly if the abscess causes gastrointestinal obstruction or inflammation. Chronic symptoms, including weight loss or night sweats, may suggest a more prolonged or insidious process. Understanding the timeline of symptom onset and progression is vital, as acute abscesses, such as those following appendicitis or diverticular perforation, often present rapidly with severe pain and systemic infection. At the same time, more chronic presentations may suggest underlying conditions like Crohn disease or postsurgical complications.
A detailed surgical history is essential, given that over 60% of intraabdominal abscesses are hospital-acquired, frequently resulting from anastomotic leaks, foreign body retention, or surgical contamination. A history of recent abdominal or pelvic surgery, trauma, or invasive procedures like peritoneal dialysis is highly relevant. Preexisting conditions such as inflammatory bowel disease, diverticulitis, or malignancy may predispose individuals to abscess formation. Infectious history is also critical; for example, endocarditis may point to splenic or hepatic abscesses, while a history of tuberculosis or amebiasis in endemic regions may suggest less common infectious causes. Social and environmental factors, such as intravenous drug use, travel to areas endemic for specific pathogens like Entamoeba histolytica, or dietary habits, may further inform the evaluation.
Risk factors such as diabetes mellitus, malignancy, immunosuppressive therapy, or recent antibiotic use can increase susceptibility to infection and complicate management, with poorly controlled diabetes associated with severe or polymicrobial abscesses. A review of systems can uncover related symptoms, such as diarrhea, constipation, urinary frequency, or dysuria, which may suggest abscesses adjacent to the gastrointestinal or urinary tract. For instance, pelvic pain might indicate a tubo ovarian abscess, while right upper quadrant pain with referred shoulder pain could suggest a hepatic abscess. Attention should also be given to systemic signs of sepsis, including high fever, chills, hypotension, tachycardia, and mental status changes, as these indicate advanced infection requiring urgent intervention. A comprehensive history enables clinicians to narrow the differential diagnosis, identify infection sources, and effectively guide diagnostic and therapeutic strategies.
Physical
The physical examination of a patient with an abdominal abscess often reveals signs of localized or systemic infection, ranging from subtle findings in mild cases to overt evidence of sepsis in severe presentations. The patient's general appearance may indicate distress, fatigue, or malaise, with potential pallor, diaphoresis, and tachypnea if sepsis or systemic inflammatory response syndrome is present. Fever is a common finding, though it may be absent in immunosuppressed individuals or those with chronic abscesses. Tachycardia, hypotension, and altered mental status suggest hemodynamic instability, a marker of advanced infection or septic shock. Many patients will be dehydrated and oliguric.[8][48]
Abdominal examination typically reveals tenderness, often localized to the abscess region, though generalized tenderness may be present in cases of associated peritonitis. Guarding, rebound tenderness, or rigidity may indicate irritation of the peritoneum. Palpation might reveal a palpable mass or fullness, particularly with superficial or large abscesses. For example, a pelvic abscess might be appreciated as tenderness in the lower abdomen, whereas a subphrenic abscess could cause referred shoulder pain or tenderness in the right upper quadrant.[49] Percussion may elicit tympany if an abscess has caused bowel obstruction or a dull note over a large collection. Auscultation may reveal diminished bowel sounds suggestive of ileus or inflammation affecting gastrointestinal motility.
Additional signs may point to specific abscess locations or complications. For example, jaundice or hepatomegaly may accompany a hepatic abscess, while flank tenderness or costovertebral angle pain might suggest a retroperitoneal or renal source. Pelvic examination in female patients may reveal adnexal tenderness, a palpable mass, or cervical motion tenderness, raising suspicion for a tubo ovarian abscess or pelvic inflammatory disease. A rectal examination might identify tenderness, fluctuance, or masses suggesting a perirectal or deep pelvic abscess.
The presentation and physical findings may also vary based on the etiology and location of the abscess. For example, Crohn disease is commonly associated with abdominal pain and weight loss, which may precede the formation of an abscess.[50] In postsurgical individuals, the diagnosis of an abdominal abscess may be delayed due to analgesia, but fever, pain, nausea, and anorexia may raise suspicion. A subphrenic abscess may present with shoulder pain, hiccups, or atelectasis.[49] A tubo ovarian abscess may present with abdominal pain, nausea, vomiting, diarrhea, and fevers.[41] A foul odor and crepitance upon palpation often characterize anaerobic infections.[51] If the abscess extends into extraabdominal locations, such as the chest, lower back, gluteals, sacrum, coccyx, or leg, it will cause pain in these areas.[40] If the abscess is retroperitoneal or located deep in the pelvis, signs and symptoms may be vague and relatively minor, including fever, mild liver dysfunction, or prolonged ileus.[52]
In patients with signs of systemic infection or instability, physical examination should extend beyond the abdomen to assess for complications like respiratory distress (suggestive of subphrenic abscess) or joint or extremity findings that could indicate hematogenous spread or septic arthritis. Findings like erythema, warmth, or induration overlying the abdomen might indicate a superficial abscess or cellulitis. In all cases, physical exam findings should be correlated with the clinical history and imaging studies to confirm the diagnosis and guide management.
Evaluation
The evaluation of a patient with suspected intraabdominal abscess begins with a thorough history and physical examination, followed by targeted diagnostic testing to confirm the diagnosis, determine the abscess's location, and assess for complications. Key components of the evaluation include bloodwork, imaging, and microbiological cultures. Laboratory results often reveal leukocytosis, abnormal liver function, anemia, and thrombocytopenia. Blood cultures may be negative, but when positive, they frequently show anaerobic organisms, with B fragilis being one of the most common.
Other markers, such as CRP and procalcitonin, can help assess the level of inflammation or infection, guiding further management. Serum markers like cancer antigen 125 may also be useful in predicting disease severity in cases such as complicated diverticulitis, where higher levels correlate with larger abscesses and a need for more invasive interventions.[53] A retrospective cohort designed to establish a prediction model for the detection of postoperative organ space and surgical site infection in those who underwent gastrointestinal or hepatopancreatobiliary cancer resection determined that laboratory data on postoperative day 3 was predictive of infection.[54]
Imaging is crucial in confirming the diagnosis and determining the abscess’s location and relationship to other structures. Ultrasound is often the first imaging modality, especially in children, due to its availability and lack of radiation. For adults, contrast-enhanced computed tomography (CT) is the gold standard for diagnosing intraabdominal abscesses. This imaging can reveal detailed information about the abscess’s size, location, and relationship with surrounding organs, and it can also help identify the source of contamination, such as perforated diverticula, appendicitis, or bowel perforation. CT is preferred because it is less affected by bandages or drains and allows for better visualization when intravenous contrast is used. In pregnant individuals, ultrasound or magnetic resonance imaging (MRI) is preferred due to the need to avoid radiation.[8][45] MRI is rarely used but can provide detailed soft tissue imaging, especially in complex cases.
CT-guided aspiration is another key diagnostic tool, allowing for sampling the abscess for microbiological cultures and, if necessary, placing an indwelling drain to help resolve the infection.[48][55][56][57] Repeat imaging and cultures may be necessary if there is no clinical response to antibiotics after several days, especially in cases caused by anaerobes.[45] Indications that anaerobes are present include odor, gas formation within the abscess, bowel and vascular structures, and the portal venous system.[51]
In addition to standard imaging, experimental technologies are being explored to improve diagnosis and treatment outcomes. Results from a study describe a method for measuring the optical properties of an abscess cavity and the uptake of methylene blue as part of a technique for photodynamic therapy, which may help treat recurrent or antibiotic-resistant collections.[58] Finally, specific recommendations from the 2024 Clinical Practice Guidelines from the Infectious Diseases Society of America for adults and adolescents with suspected intraabdominal abscesses suggest that CT should be the initial imaging modality, with the option of intravenous contrast to improve visualization of the abscess wall. In cases where imaging fails to provide a clear diagnosis or in the absence of clinical response to treatment, repeated imaging and cultures may be warranted to assess for complications or to guide therapeutic interventions.
Treatment / Management
Source control is paramount in treating intraabdominal abscesses and involves a combination of antibiotics, drainage, debridement, and removal of foreign bodies. Broad-spectrum antibiotics are initiated early and tailored based on culture results. The decision between drainage and antibiotics alone is debated, with abscess size and biomarkers like CRP playing a role in guiding management.[59] Adjuncts, including nasogastric tubes and parenteral nutrition, may support recovery.[43][60][61] Percutaneous image-guided drainage has been shown to decrease the duration of hospitalization. In most patients, improvement occurs within 48 hours after drainage. CT-guided drainage has a success rate of over 90% for localized abscesses and is the standard of care. Algorithms for drain management are based on the size and etiology of the abscess. Crohn disease, for example, is associated with fistula formation, and persons with related abscesses may require additional imaging.[62] An abscess that fails drain management or is inaccessible to percutaneous drainage requires surgical drainage.[63][64][65] (B2)
The Infectious Disease Society of America published an update on intraabdominal infections in adults, children, and pregnant persons, including guidance regarding an intraabdominal abscess. Recommendations include risk stratification, using the Acute Physiology and Chronic Health Evaluation II score, which estimates mortality at intensive care unit (ICU)-level care, or the World Society of Emergency Surgery Sepsis Severity Score to assess the severity of illness for use within 24 hours of hospital or ICU admission. The authors note the absence of such a scoring system for pediatric individuals and recommend a CT for initial imaging in nonpregnant persons and adolescents with a suspected intraabdominal abscess, including intravenous contrast and ultrasound for children. CT or MRI is designated as an alternative, although either may require sedation. For pregnant persons, MRI or ultrasound is the suggested imaging modality.[66]
The Surgical Infection Society Guidelines for Management of Intraabdominal Infection include recommendations for antimicrobial therapy formulated from analysis of clinical trial data based on risk stratification and provide detailed guidance depending on the organism and calculated patient risk. General recommendations include initiation of antimicrobial therapy within an hour in high-risk patients with sepsis and warning that delays over 6 hours increase mortality.[67] The World Journal of Emergency Surgery published guidelines of the Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use in intraabdominal infections. Using an effective antibiotic improves outcomes, including minimizing antibiotic resistance and opportunistic infections. The guidelines note the growth of multidrug-resistant organisms, especially gram-negative bacteria, and emphasize early source control, including image-guided drainage. The council also recommends early empiric antibiotic treatment to improve outcomes in septic persons. The guidelines emphasize an individualized approach to antibiotic therapy to improve efficacy and reduce resistance. Guidelines for specific disease entities are provided in the publication.[45] A recent study's results demonstrated gram-negative bacteria within an intraabdominal abscess were most responsive to meropenem, followed by piperacillin-tazobactam, and gram-positive bacteria were over 80% responsive to amoxicillin-clavulanic acid, piperacillin-tazobactam, and meropenem.[7][68] (A1)
The approach to abscess treatment varies by anatomic location. While a subdiaphragmatic abscess can be drained percutaneously, a pelvic abscess is accessed transrectally or transvaginally. Endoscopic ultrasound-guided drainage provides a safe and effective minimally invasive treatment option.[69][70] Transesophageal and transgastric approaches have been used for a subphrenic abscess.[71] Splenic abscesses have been traditionally treated with splenectomy, but percutaneous drainage has been correlated with lower mortality and complication rates.[72] Results from a study showed that abscess size, age, inflammatory markers, leukocytosis, and erythrocyte sedimentation rate were predictive of the need for surgical intervention due to failure of pharmacologic treatment.[73](A1)
Study results have demonstrated the benefits of using a nonoperative approach with drain placement for appendicitis with abscesses. These include fewer complications, shorter hospitalizations, fewer wound infections, and reduced incidence of ileus.[65][74][75] A multicenter study on the impact of a prophylactic drain in the setting of perforated appendicitis in adults provided results that showed drain placement did not reduce the incidence of an abscess and was associated with a longer hospital stay. Operative grade, as described by the American Association for the Surgery of Trauma, was associated with abscess risk.[76] An abscess size of less than 4 cm is associated with successful percutaneous drain management of appendicitis-related abscesses in the pediatric population.[77] Results from a postoperative study in pediatric perforated appendicitis with abscess demonstrated the interval between diagnosis and percutaneous drainage was not associated with the need for additional intervention, drain dwell time, or length of stay.[78] In a study of 1766 postappendectomy abscesses in children treated with antibiotics, 67 of whom had abscesses smaller than 6 cm, and 22 of whom had an abscess larger than 6 cm, results showed that abscess size did impact the duration of intravenous treatment and hospital stay.[79](A1)
Abscess size amenable to percutaneous drainage differs by anatomical location and etiology. An abscess of 3 to 6 cm is generally accepted as a cutoff for a diverticular abscess that can be successfully treated with percutaneous drainage.[77] Results from a study indicated that surgical intervention for collections of less than 4 cm lowers the risk of a recurrent diverticular abscess.[80] A multicenter study in Spain evaluated outcomes following the first-time diagnosis of a diverticular abscess to develop a model to predict the need for emergency surgery. Per the study's results, immunosuppression, CRP, free air, and larger abscess size were associated with the need for emergency surgery.[81]
Persons with Crohn disease may form spontaneous abscesses, and treatment, either immediate resection or nonoperative management, depends on clinical presentation. Study results show good surgical outcomes following initial nonoperative management of a Crohn abscess.[82] A study evaluating the treatment of Crohn abscess across periods of 1, 2, and 5 years found abscess diameter, width of sinus, and abscess location associated with the need for invasive treatment.[83] Results from additional studies have shown that factors including bowel wall thickness, dilation, length of the involved segment, and abscess greater than 6 cm are related to the need for subsequent surgery.[84] A study compared antibiotics, percutaneous drainage, and surgical drainage in persons with Crohn disease; the results described abscess size to be a factor in treatment efficacy. Where abscesses greater than 30 mm were responsive to antibiotics, surgery was superior to percutaneous drainage for an abscess less than 50 mm but with a higher complication rate. The authors concluded that percutaneous drainage is safer than surgery and generally as effective.[17] Those who recover following nonoperative treatment of a Crohn abscess are shown to benefit from anti-tumor necrosis factors. This biologic medication decreases inflammation by blocking the tumor necrosis factor protein. Biologic therapy is most successful in those who have not previously undergone resection.[17][18][50](B2)
Studies have been conducted on the ideal timing for surgical intervention in those with Crohn disease who have undergone percutaneous drainage of an intraabdominal abscess. A multicenter study assessed outcomes in those with Crohn disease who underwent percutaneous drainage of an abscess within 6 weeks before resection, and the results showed morbidity and anastomotic leak higher in that group.[85] A multicenter cohort looked at 30-day postoperative complications and intraoperative adverse events, including sepsis, surgical site infections, postoperative ileus, and abscess recurrence in those undergoing resection for Crohn disease following nonoperative abscess drainage. The author's results showed that age, residual abscess, smoking status, low serum albumin, and time interval to surgery were associated with postoperative complications.[86]
For aseptic abscess syndrome in those with inflammatory bowel disease, antibiotics are ineffective, and most persons respond to intravenous corticosteroids followed by maintenance therapy with biologic therapy consisting of antibodies or disease-modifying antirheumatic drugs and steroids. Some patients relapse on steroids alone, and relapse must be differentiated from opportunistic infections that can be prompted by immunosuppressive therapy.[39] Innovation continues to expand the treatment arsenal for an intraabdominal abscess.(B3)
A newer therapy intended for difficult-to-treat, persistent, or recurrent abscesses involves photodynamic therapy, using reactive oxygen species as an antimicrobial, used in conjunction with methylene blue as a photosensitizer. Evaluating absorbed light and photosensitization, researchers published results from the first study that measured the optical properties of an abscess. An optical probe collected data within the abscess, and the cavity was infused with methylene blue. The uptake of methylene blue was measured, and photodynamic therapy was implemented within the abscess. There was no statistical difference in methylene blue uptake between antimicrobial-resistant and susceptible microbes.[58]
Differential Diagnosis
The differential diagnosis for an intraabdominal abscess is broad, as the presenting symptoms are nonspecific and can overlap with various conditions. These symptoms often include fever, abdominal pain, nausea, and vomiting. Many intraabdominal space-occupying masses can be distinguished radiographically, and a thorough history, physical examination, and early radiographic findings are essential in narrowing the diagnosis. Conditions that may present similarly to an intraabdominal abscess include:
- Malignancy
- Tumors or cancers, particularly in the gastrointestinal tract (eg, colorectal cancer), pancreas, liver, or ovaries, may present with a mass-like lesion that could be mistaken for an abscess. Malignant tumors may also undergo necrosis, leading to fluid collections that resemble abscesses.
- Benign mass
- Nonmalignant masses, such as fibroids or lipomas, could present with similar clinical features as an abscess, particularly if they are large and cause localized abdominal pain or discomfort.
- Fever of unknown origin
- An intraabdominal abscess may present with fever, but fever of unknown origin has a broad differential, including infections, malignancies, and inflammatory conditions, all of which need to be considered.
- Hernia
- Abdominal hernias, particularly those that are incarcerated or strangulated, can present with localized pain, fever, and abdominal distension, mimicking the presentation of an abscess.
- Hematoma
- Abdominal hematomas resulting from trauma or surgery can present with a mass, tenderness, and pain that may be difficult to differentiate from an abscess, particularly in the postoperative setting.
- Organ infarction
- Infarction of intraabdominal organs, such as the spleen or liver, can cause localized pain and form fluid collections resembling an abscess.
- Ascites
- The accumulation of fluid within the peritoneal cavity due to liver disease, malignancy, or heart failure can present with abdominal distension and tenderness. While ascites can sometimes be complicated by infection, this condition should be distinguished from an abscess.
- Peritonitis
- An infection or inflammation of the peritoneum can cause symptoms and signs that mimic an abscess, including fever, tenderness, and abdominal distension.
- Other considerations
- Pancreatic pseudocysts
- Inflammatory bowel diseases
Pertinent Studies and Ongoing Trials
Yuan et al studied factors associated with the development of an intraabdominal abscess following laparoscopic appendectomy for perforated appendicitis in older adults. Their results found a correlation between a lower prognostic nutritional index and increased risk for abscess within 30 days.[87] Smith et al conducted a retrospective study within 13 level I and II trauma centers, including adults with grade 3 and higher trauma to the liver who underwent operative intervention to determine risk factors associated with abscess formation. Out of the 372 persons studied, 79 (21.2%) developed an abscess. The study results described that the mechanism of injury, initiation of intraoperative massive transfusion protocol, presence of bile leak, hospital length of stay, and additional injuries were independent risk factors for the development of an abscess.[88]
Intrabdominal abscess following pancreatic surgery was found to be an independent risk factor for delayed postpancreatectomy hemorrhage, more likely to occur in those who did not undergo drainage for their abscess.[89] Zheng et al studied perforated appendicitis in pediatric patients to determine predictive laboratory values for the formation of an abscess; the results showed significant overlap between those with and without an abscess.[90]
A study of the efficacy of intraoperative peritoneal lavage on the prevention of postoperative abscess evaluated 10 randomized controlled trials, including 1318 persons with appendicitis or peritonitis, and the results demonstrated that this practice was not associated with reduced mortality, abscess, surgical site infections, complications, reoperation, or readmission.[91] Jen et al studied the impact of postdischarge antibiotics on the formation of an abscess in children treated for perforated appendicitis at their institution, and the results showed that antibiotics did not reduce the incidence of an abscess.[92]
Results from a retrospective study of 592 pediatric patients who underwent surgery for acute appendicitis demonstrated that those who received antibiotics in the first 8 hours of diagnosis reduced the incidence of an intraabdominal abscess from 25% to 5.5%.[93] A multicenter study was conducted of persons who underwent nonoperative treatment of a diverticular abscess with either antibiotics alone or in conjunction with percutaneous drainage to identify independent risk factors for those who require emergency surgery. Of the included persons, 27% needed emergency surgery, and predictors of nonoperative treatment failure included a Hinchey abscess classification IIb or greater, air within the abscess cavity, and smoking status.[94]
Results from a study conducted in Italy by Frediani et al demonstrated the efficacy of intraperitoneal irrigation with cefazolin at the end of a laparoscopic appendectomy in preventing a postoperative abscess.[95] Researchers generated a classification system utilizing the degree of contamination in perforated appendicitis to predict outcomes. They demonstrated more postoperative complications, including intraabdominal abscess, in the group with the most widespread contamination than other groups evaluated.[96]
Prognosis
Several critical factors, including timely diagnosis and intervention, patient comorbidities, abscess characteristics, and management effectiveness, influence the prognosis of intraabdominal abscesses. Complicated intraabdominal infections can carry mortality rates of up to 40%, particularly when associated with sepsis, delayed diagnosis, or inadequate source control.[33] Key variables such as advanced age, malnutrition, diabetes, chronic anemia, and limited access to surgical centers exacerbate the clinical severity, increasing the risks of perforation, peritonitis, and abscess formation.[97]
Prognostic Factors and Outcomes
Timely and effective source control, such as image-guided drainage, is pivotal in reducing morbidity and improving survival rates. Delays in treatment—especially beyond 6 hours in patients with sepsis—markedly increase mortality.[45] Sepsis, recurrent surgeries, and loculated abscesses further elevate the risks.[33] Additionally, prognostic laboratory markers like elevated CRP (>12.06 mg/dL) and blood urea nitrogen (>21 mg/dL) are associated with a higher likelihood of requiring inotropic support and poorer outcomes.[48]
Study results highlight the importance of abscess size in determining the success of conservative management. Larger abscesses, particularly in diverticular disease, are more likely to fail nonsurgical interventions.[98] Postoperative intraabdominal infections, especially in individuals with cancer, may negatively impact short-term outcomes such as recurrence-free intervals but do not significantly affect long-term survival in colorectal cancer patients.[99]
Mortality and Complications
If untreated or misdiagnosed, intraabdominal abscesses have a very high mortality rate. Key factors contributing to mortality and morbidity include:
- Sepsis and organ dysfunction
- Delay in initiating appropriate treatment
- Advanced age and associated frailty
- Presence of multiple comorbidities, such as diabetes or immunosuppression
- Loculated or complex abscess collections that require advanced drainage techniques
Advances in Management and Prognosis
Image-guided drainage, often the first-line intervention for accessible abscesses, significantly reduces morbidity by avoiding invasive surgery. Surgical options, including laparotomy or laparoscopy, can achieve effective source control for abscesses resistant to percutaneous drainage. The size of the abscess and the presence of other complications often influence elective or urgent surgery for diverticular abscesses.
Complications
An intraabdominal abscess, often arising as a complication of surgery or untreated intraabdominal infections, can lead to significant morbidity and mortality if not managed appropriately. Local complications include peritonitis due to abscess rupture, fistula formation into adjacent organs, bowel obstruction from inflammatory edema or adhesions, and erosion into vascular structures resulting in catastrophic hemorrhage. Chronic inflammation may also lead to adhesions, fibrosis, and recurrent abscesses, complicating future surgeries. Systemic complications include sepsis, septic shock, multiorgan dysfunction syndrome, bacteremia, infective endocarditis, thromboembolic events, and systemic inflammatory response syndrome. Long-term sequelae, such as chronic pain, malnutrition, and recurrent abscesses, are common, especially in patients with underlying comorbidities.
Drainage of abscesses, whether percutaneous or surgical, is a critical component of treatment but carries its risks. Incomplete drainage may leave a residual abscess cavity prone to biofilm formation and antibiotic resistance.[58] Drain-related complications include perforation of nearby viscera or blood vessels, retrograde infection due to prolonged indwelling time, and clogging from drain sampling for culture.[100] Persistent infection or inadequate drainage can result in septic sequelae, including deep vein thromboses and complications like fistula formation.
Timely and effective source control, such as early drainage and appropriate antibiotic therapy, is essential to reduce morbidity and mortality. Prognosis is heavily influenced by factors such as the patient’s age, comorbidities (eg, diabetes or chronic anemia), sepsis, and the timeliness of intervention. Preventing complications requires a multidisciplinary approach, including precise imaging for diagnosis, careful selection of drainage techniques, and vigilant postprocedure monitoring for signs of recurrence or systemic deterioration.
Postoperative and Rehabilitation Care
Postoperative and rehabilitative care for patients recovering from an intraabdominal abscess focuses on promoting healing, preventing recurrence, and addressing complications. Regular clinical assessments and imaging, such as ultrasound or CT scans, are essential to confirm abscess resolution and detect potential complications like recurrent abscesses, fistulas, or persistent infections. Continued antibiotic therapy tailored to culture results is critical for eradicating residual infection, with vigilance for signs of sepsis or secondary infections. Proper management of surgical or percutaneous drains, including timely removal, helps minimize the risk of retrograde infections or clogging. Nutritional support is vital, focusing on a high-protein, nutrient-rich diet or supplemental enteral or parenteral nutrition for those with significant weight loss or poor oral intake.
Rehabilitation programs should gradually reintroduce physical activity to prevent complications such as deep vein thrombosis and promote overall recovery. Optimizing chronic conditions like diabetes, anemia, or immunosuppression is crucial to enhance recovery and reduce the risk of recurrence. Additionally, addressing mental health needs and providing psychological support can help patients manage stress or anxiety related to their illness or prolonged recovery. Comprehensive, interdisciplinary care is essential to ensure a successful recovery and minimize long-term sequelae.
Consultations
Care for a person with an intraabdominal abscess necessitates a collaborative, interprofessional approach involving multiple specialists. Radiologists and interventional radiologists are critical for diagnosing and managing abscesses with imaging and percutaneous drainage. General surgeons oversee surgical interventions when drainage is insufficient, or the abscess is inaccessible. Gastroenterologists may assist in managing underlying conditions such as Crohn disease, while oncologists and gynecologists may be involved depending on the etiology, such as malignancy or gynecologic sources. Pharmacists ensure appropriate antibiotic stewardship and infectious disease experts guide antimicrobial therapy based on culture data. This teamwork is essential for optimizing outcomes and patient safety.
Deterrence and Patient Education
Deterrence and patient education are vital components in managing and preventing intraabdominal abscesses. Patients should be counseled on the importance of timely medical evaluation for abdominal pain, fever, or signs of infection, as delays in diagnosis and treatment can lead to severe complications. Educating patients about the risks associated with surgical procedures, particularly those with predisposing factors such as diabetes, immunosuppression, or malnutrition, can help them understand their role in preventing infections. Patients should be advised on the importance of adhering to prescribed antibiotics and completing the full course of therapy to reduce the risk of recurrence or resistance.
For those undergoing surgical or percutaneous interventions, proper wound care and awareness of signs of wound infection are crucial. Maintaining optimal nutrition and controlling underlying chronic conditions, such as diabetes or anemia, are essential preventive strategies. In cases where abscess formation is linked to specific diseases, such as diverticulitis or inflammatory bowel disease, patients should be educated about managing these conditions and recognizing early signs of complications. Encouraging regular follow-ups and imaging studies when indicated ensures ongoing monitoring and early intervention if needed. Empowering patients with knowledge and resources fosters better outcomes and reduces the likelihood of recurrence.
Pearls and Other Issues
Antibiotic stewardship is important and reduces healthcare-associated infections and associated costs. Recommendations include using the hospital antibiogram and screening for carbapenemase-producing Enterobacter. Also, monitoring the intraperitoneal flora throughout hospitalization to avoid increasingly resistant strains during subsequent intervention is important. Consulting with a pharmacist and an infectious disease specialist will help guide decision-making.[7][45] Results from a study of pediatric patients who developed a postappendectomy abscess, 50% of collections cultured contained a resistant organism, including 20% E coli, over 92% Pseudomonas, and 100% Enterococcus, suggesting the need for culture results to target antibiotic therapy.[101]
The immediate physiologic impact of an intraabdominal abscess is significant. While many suspect pulmonary embolus as the etiology for decompensation following trauma laparotomy or prolonged hospitalization, in a study of persons who underwent CT scan for clinical deterioration after a trauma laparotomy, only 3 had a central pulmonary embolus, 18 peripheral emboli, and 222 had an abscess, phlegmon or pseudoaneurysm.[102] Postoperative infection in persons with malignancy contributes to recurrence and reduced overall and disease-free survival.[103][104]
Visceral fat may be correlated with risk for postoperative complications, including intraabdominal abscess.[105][106] A study of patients undergoing laparoscopic pancreaticoduodenectomy provided results showing that those with greater abdominal depth to body mass ratio had a higher prevalence of complications. Researchers found a ratio greater than 2.7 m³/kg to be an independent risk factor for postoperative complications.[107] Improving the nutrition of those with low skeletal muscle mass may reduce postoperative infections.[108] Preoperative enteral nutrition may reduce postoperative complications, including an abscess in persons with Crohn disease.[109] Individuals who were part of an enhanced recovery after surgery program following gastrectomy for gastric cancer had fewer intraabdominal abscesses compared with those who were not part of the program.[110] Sarcopenic persons who underwent hepatectomy for hepatocellular carcinoma had an increased incidence of intraabdominal abscess and bile leak, and sarcopenia was found to be an independent risk factor for these events.[111] Imaging in aseptic abscess syndrome may reveal multiple abscesses within the spleen, liver, lungs, kidney, pancreas, lymph nodes, brain, and testes. If a person with this presentation has not been previously diagnosed with inflammatory bowel disease, they will require a colonoscopy.[39]
Enhancing Healthcare Team Outcomes
Managing an intraabdominal abscess requires a coordinated interprofessional approach involving clinicians, nurses, pharmacists, and other healthcare professionals. Only through a systematic clinical interprofessional team approach can the morbidity and mortality of an abdominal abscess be reduced.[112][113] These abscesses can be challenging to diagnose and treat, and timely, effective communication among the team is crucial. Nurses and advanced clinicians play a key role in continuous monitoring for signs of deterioration, including drain output and patient’s clinical status. The surgical team oversees interventions, ensuring timely source control and managing any complications.
Pharmacists are integral to directing antibiotic therapy, ensuring regimens are tailored to culture results and hospital antibiograms, which help combat resistant organisms. Nutritionists contribute significantly by calculating caloric needs and addressing dietary deficiencies, particularly for patients requiring total parenteral nutrition. The surgical team provides critical oversight, monitoring drain outputs and clinical status to prevent delays in treatment, which could lead to adverse events and increased healthcare costs. The key to improving outcomes for intraabdominal abscesses is a coordinated interprofessional approach, with prompt diagnosis, vigilant monitoring, and early, targeted treatment.[114][38]
References
Ozgun YM, Oter V, Piskin E, Colakoglu MK, Aydin O, Aksoy E, Dalgic T, Bostanci EB. Treatment Modalities and the Role of Endoscopy for Delayed Gastric Emptying After Whipple Operation: Analysis of 53 Patients. The American surgeon. 2022 Feb:88(2):273-279. doi: 10.1177/0003134821989037. Epub 2021 Jan 31 [PubMed PMID: 33517709]
Alharbi KS, Singh Y, Hassan Almalki W, Rawat S, Afzal O, Alfawaz Altamimi AS, Kazmi I, Al-Abbasi FA, Alzarea SI, Singh SK, Bhatt S, Chellappan DK, Dua K, Gupta G. Gut Microbiota Disruption in COVID-19 or Post-COVID Illness Association with severity biomarkers: A Possible Role of Pre / Pro-biotics in manipulating microflora. Chemico-biological interactions. 2022 May 1:358():109898. doi: 10.1016/j.cbi.2022.109898. Epub 2022 Mar 21 [PubMed PMID: 35331679]
Thompson DT, Hrabe JE. Intra-abdominal and Anorectal Abscesses. Gastroenterology clinics of North America. 2021 Jun:50(2):475-488. doi: 10.1016/j.gtc.2021.02.014. Epub 2021 Apr 23 [PubMed PMID: 34024453]
Sarychev LP, Sarychev YV, Pustovoyt HL, Sukhomlin SA, Suprunenko SM. Management of the patients with blunt renal trauma: 20 years of clinical experience. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2018:71(3 pt 2):719-722 [PubMed PMID: 29783255]
Son DJ, Hong JY, Kim KH, Jeong YH, Myung DS, Cho SB, Lee WS, Kang YJ, Kim JW, Joo YE. Liver abscess caused by Clostridium haemolyticum infection after transarterial chemoembolization for hepatocellular carcinoma: A case report. Medicine. 2018 May:97(19):e0688. doi: 10.1097/MD.0000000000010688. Epub [PubMed PMID: 29742715]
Level 3 (low-level) evidenceSerraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, Melchio R, Fenoglio LM. Characteristics and management of pyogenic liver abscess: A European experience. Medicine. 2018 May:97(19):e0628. doi: 10.1097/MD.0000000000010628. Epub [PubMed PMID: 29742700]
Méchaï F, Kolakowska A, Carbonnelle E, Bouchaud O, Tresallet C, Jaureguy F. Intra-abdominal abscesses: Microbiological epidemiology and empirical antibiotherapy. Infectious diseases now. 2023 Feb:53(1):104604. doi: 10.1016/j.idnow.2022.08.005. Epub 2022 Sep 5 [PubMed PMID: 36067948]
Bonomo RA, Tamma PD, Abrahamian FM, Bessesen M, Chow AW, Dellinger EP, Edwards MS, Goldstein E, Hayden MK, Humphries R, Kaye KS, Potoski BA, Rodríguez-Baño J, Sawyer R, Skalweit M, Snydman DR, Donnelly K, Loveless J. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Intra-abdominal Abscess in Adults, Children, and Pregnant People. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2024 Oct 4:79(Supplement_3):S113-S117. doi: 10.1093/cid/ciae351. Epub [PubMed PMID: 38963815]
Level 1 (high-level) evidenceÇay Ü, Alabaz D, Ö Gündeşlioglu Ö, Tutuş K, K Çil M, Pehlivan UA. Multi-organ/disseminated echinococcosis in children: Case series and review of the literature. Journal of paediatrics and child health. 2022 Jul:58(7):1193-1200. doi: 10.1111/jpc.15942. Epub 2022 Mar 8 [PubMed PMID: 35262239]
Level 2 (mid-level) evidenceGray M, Marland JRK, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. Journal of personalized medicine. 2021 May 25:11(6):. doi: 10.3390/jpm11060471. Epub 2021 May 25 [PubMed PMID: 34070593]
Iritani S, Kawamura Y, Yamashige D, Muraishi N, Kajiwara A, Fujiyama S, Sezaki H, Hosaka T, Akuta N, Kobayashi M, Kobayashi M, Saitoh S, Suzuki F, Arase Y, Ikeda K, Suzuki Y, Kumada H. An encapsulated bulky abdominal abscess due to amoeba. Clinical journal of gastroenterology. 2021 Apr:14(2):555-559. doi: 10.1007/s12328-020-01331-0. Epub 2021 Jan 11 [PubMed PMID: 33428067]
Nishikawa M, Honda M, Kimura R, Kobayashi A, Yamaguchi Y, Hori S, Kobayashi H, Waragai M, Kawamura H, Nakayama Y, Todate Y, Takano Y, Yamaguchi H, Hamada K, Iketani S, Seto I, Izumi Y, Seto K. The bacterial association with oral cavity and intra-abdominal abscess after gastrectomy. PloS one. 2020:15(11):e0242091. doi: 10.1371/journal.pone.0242091. Epub 2020 Nov 9 [PubMed PMID: 33166362]
Lim RS, See YP. Pyogenic liver abscesses in peritoneal dialysis patients: A single-centre retrospective case series. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 2024 Nov:44(6):459-462. doi: 10.1177/08968608241239798. Epub 2024 Apr 21 [PubMed PMID: 38644580]
Level 2 (mid-level) evidenceAlemu BN, Tiruneh AG. Gossypiboma: A Case Series and Literature Review. Ethiopian journal of health sciences. 2020 Jan:30(1):147-149. doi: 10.4314/ejhs.v30i1.19. Epub [PubMed PMID: 32116444]
Level 2 (mid-level) evidenceRasslan R, Alves V, Damous SHB, de Santis A, Tarasoutchi F, Menegozzo CAM, Akamine M, Rasslan S, Utiyama EM. Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil. Journal of investigative surgery : the official journal of the Academy of Surgical Research. 2022 Nov-Dec:35(11-12):1836-1840. doi: 10.1080/08941939.2022.2130481. Epub 2022 Oct 6 [PubMed PMID: 36202396]
Liu A, Liu H, Ding X, Wu J, Tian Z, Mao T. Familial adenomatous polyposis associated with desmoid tumors presenting with abdominal abscess: A case report and literature review. Medicine. 2021 Nov 19:100(46):e27897. doi: 10.1097/MD.0000000000027897. Epub [PubMed PMID: 34797340]
Level 3 (low-level) evidenceCasas Deza D, Polo Cuadro C, de Francisco R, Vela González M, Bermejo F, Blanco I, de la Serna Á, Bujanda L, Bernal L, Rueda García JL, Gargallo-Puyuelo CJ, Fuentes-Valenzuela E, Castro B, Guardiola J, Ladrón G, Suria C, Sáez Fuster J, Gisbert JP, Sicilia B, Gomez R, Muñoz Vilafranca C, Barreiro-De Acosta M, Peña E, Castillo Pradillo M, Cerrillo E, Calvet X, Manceñido N, Monfort I Miquel D, Marín S, Roig C, Marce A, Ramírez de Piscina P, Betoré E, Martin-Cardona A, Teller M, Alonso Abreu I, Maroto N, Frago S, Gardeazabal D, Pérez-Martínez I, Febles González ÁD, Barrero S, Taxonera C, García de la Filia I, Ezkurra-Altuna A, Madero L, Martín-Arranz MD, Gomollón F, Domènech E, García-López S. Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn's Disease: A National, Multicentre Study Based on ENEIDA Registry. Journal of Crohn's & colitis. 2024 Apr 23:18(4):578-588. doi: 10.1093/ecco-jcc/jjad184. Epub [PubMed PMID: 37930823]
Waked B, Holvoet T, Geldof J, Baert F, Pattyn P, Lobatón T, Hindryckx P. Conservative management of spontaneous intra-abdominal abscess in Crohn's disease: Outcome and prognostic factors. Journal of digestive diseases. 2021 May:22(5):263-270. doi: 10.1111/1751-2980.12984. Epub 2021 Apr 16 [PubMed PMID: 33742782]
Parillo M, Bernetti C, Altomare C, Beomonte Zobel B, Quattrocchi CC. Extrahepatic abscess and dropped gallstones: a case report and a narrative review of an unusual delayed complication of laparoscopic cholecystectomy. Acta chirurgica Belgica. 2024 Feb:124(1):57-61. doi: 10.1080/00015458.2022.2163957. Epub 2023 Jan 3 [PubMed PMID: 36576306]
Level 3 (low-level) evidenceSlezák M, Smolár M, Mikolajčík A, Janík J, Miklušica J. Appendicolith as a cause of late complications after appendectomy - a case report and literature review. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti. 2022 Spring:101(5):251-254. doi: 10.33699/PIS.2022.101.5.251-254. Epub [PubMed PMID: 35667876]
Level 3 (low-level) evidenceLee K, Lee JW, Jung HR, Park M, Cho KB, Lee JY. A case of colonic MALT lymphoma with intra-abdominal abscess and lung metastasis: A case report. Medicine. 2023 Oct 27:102(43):e35778. doi: 10.1097/MD.0000000000035778. Epub [PubMed PMID: 37904387]
Level 3 (low-level) evidenceNihei M, Kamada T, Aida T, Yamagishi D, Takahashi J, Nakashima K, Ito E, Suzuki N, Hata T, Yoshida M, Ohdaira H, Suzuki Y. Rare symptom of left inguinal abscess secondary to a retroperitoneal perforation of diverticulitis of the sigmoid colon: A case report. Medicine. 2024 Sep 27:103(39):e39770. doi: 10.1097/MD.0000000000039770. Epub [PubMed PMID: 39331910]
Level 3 (low-level) evidenceCoakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clinics in colon and rectal surgery. 2021 Mar:34(2):96-103. doi: 10.1055/s-0040-1716701. Epub 2020 Oct 21 [PubMed PMID: 33642949]
Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, Balogh ZJ, Di Saverio S, Weber D, Ten Broek RP, Abu-Zidan FM, Campanelli G, Beka SG, Chiarugi M, Shelat VG, Tan E, Moore E, Bonavina L, Latifi R, Hecker A, Khan J, Coimbra R, Tebala GD, Søreide K, Wani I, Inaba K, Kirkpatrick AW, Koike K, Sganga G, Biffl WL, Chiara O, Scalea TM, Fraga GP, Peitzman AB, Catena F. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World journal of emergency surgery : WJES. 2022 Mar 4:17(1):13. doi: 10.1186/s13017-022-00418-y. Epub 2022 Mar 4 [PubMed PMID: 35246190]
Tyan P, Abi-Khalil E, Dwarki K, Moawad G. First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities. Case reports in obstetrics and gynecology. 2016:2016():3724706. doi: 10.1155/2016/3724706. Epub 2016 Jul 27 [PubMed PMID: 27529043]
Level 3 (low-level) evidencePanigrahi MK, Kaliaperumal V, Akella A, Venugopal G, Ramadass B. Mapping microbiome-redox spectrum and evaluating Microbial-Redox Index in chronic gastritis. Scientific reports. 2022 May 19:12(1):8450. doi: 10.1038/s41598-022-12431-x. Epub 2022 May 19 [PubMed PMID: 35589904]
Kozlov A, Bean L, Hill EV, Zhao L, Li E, Wang GP. Molecular Identification of Bacteria in Intra-abdominal Abscesses Using Deep Sequencing. Open forum infectious diseases. 2018 Feb:5(2):ofy025. doi: 10.1093/ofid/ofy025. Epub 2018 Jan 24 [PubMed PMID: 29479554]
Murando F, Peloso A, Cobianchi L. Experimental Abdominal Sepsis: Sticking to an Awkward but Still Useful Translational Model. Mediators of inflammation. 2019:2019():8971036. doi: 10.1155/2019/8971036. Epub 2019 Dec 5 [PubMed PMID: 31885502]
Yoon YK, Kim J, Moon C, Lee MS, Hur J, Lee H, Kim SW. Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study. Journal of Korean medical science. 2019 Dec 9:34(47):e309. doi: 10.3346/jkms.2019.34.e309. Epub 2019 Dec 9 [PubMed PMID: 31808326]
Level 2 (mid-level) evidenceGroße K, Ohm D, Würstle S, Brozat JF, Schmid RM, Trautwein C, Stallmach A, Bruns T, Reuken PA. Clinical characteristics and outcome of patients with enterococcal liver abscess. Scientific reports. 2021 Nov 15:11(1):22265. doi: 10.1038/s41598-021-01620-9. Epub 2021 Nov 15 [PubMed PMID: 34782684]
Stultz JS, Benefield E, Lee KR, Bashqoy F, Pakyz AL. A Multicenter Analysis of Changes in Pediatric Antibiotic Susceptibilities Among Staphylococcus aureus and Pseudomonas aeruginosa Isolates: 2014-2018. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG. 2022:27(4):330-339. doi: 10.5863/1551-6776-27.4.330. Epub 2022 May 9 [PubMed PMID: 35558344]
Vogelaers D, Blot S, Van den Berge A, Montravers P, Abdominal Sepsis Study (‘AbSeS’) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine. Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units. Drugs. 2021 Jun:81(9):1065-1078. doi: 10.1007/s40265-021-01534-w. Epub 2021 May 26 [PubMed PMID: 34037963]
Bassetti M, Eckmann C, Giacobbe DR, Sartelli M, Montravers P. Post-operative abdominal infections: epidemiology, operational definitions, and outcomes. Intensive care medicine. 2020 Feb:46(2):163-172. doi: 10.1007/s00134-019-05841-5. Epub 2019 Nov 7 [PubMed PMID: 31701205]
Nakano Y, Endo Y, Kitago M, Nishiyama R, Yagi H, Abe Y, Hasegawa Y, Hori S, Tanaka M, Shimane G, Soga S, Egawa T, Okuda S, Kitagawa Y. Clinical characteristics and predictive factors of postoperative intra-abdominal abscess after distal pancreatectomy. Langenbeck's archives of surgery. 2023 May 2:408(1):170. doi: 10.1007/s00423-023-02914-4. Epub 2023 May 2 [PubMed PMID: 37127833]
Akpinar EO, Ghaferi AA, Liem RSL, Bonham AJ, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ, Dutch Audit for Treatment of Obesity (DATO) Research Group. Predicting serious complication risks after bariatric surgery: external validation of the Michigan Bariatric Surgery Collaborative risk prediction model using the Dutch Audit for Treatment of Obesity. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2023 Mar:19(3):212-221. doi: 10.1016/j.soard.2022.09.008. Epub 2022 Sep 15 [PubMed PMID: 36274015]
Level 1 (high-level) evidenceLin YJ, Ho TW, Wu CH, Kuo TC, Yang CY, Wu JM, Tien YW. Specific Bile Microorganisms Caused by Intra-Abdominal Abscess on Pancreaticoduodenectomy Patients: A Retrospective Cohort Study. Current oncology (Toronto, Ont.). 2021 Dec 27:29(1):111-121. doi: 10.3390/curroncol29010009. Epub 2021 Dec 27 [PubMed PMID: 35049683]
Level 2 (mid-level) evidenceMao BP, Collins G, Ayeni FE, Vagg DJ. Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study. Langenbeck's archives of surgery. 2024 Aug 9:409(1):246. doi: 10.1007/s00423-024-03421-w. Epub 2024 Aug 9 [PubMed PMID: 39120614]
Level 2 (mid-level) evidenceCirocchi R, Afshar S, Shaban F, Nascimbeni R, Vettoretto N, Di Saverio S, Randolph J, Zago M, Chiarugi M, Binda GA. Perforated sigmoid diverticulitis: Hartmann's procedure or resection with primary anastomosis-a systematic review and meta-analysis of randomised control trials. Techniques in coloproctology. 2018 Oct:22(10):743-753. doi: 10.1007/s10151-018-1819-9. Epub 2018 Jul 11 [PubMed PMID: 29995173]
Level 1 (high-level) evidenceFillman H, Riquelme P, Sullivan PD, Mansoor AM. Aseptic abscess syndrome. BMJ case reports. 2020 Oct 29:13(10):. doi: 10.1136/bcr-2020-236437. Epub 2020 Oct 29 [PubMed PMID: 33122231]
Level 3 (low-level) evidenceSimsek A. Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis. Wounds : a compendium of clinical research and practice. 2021 Sep:33(9):226-230 [PubMed PMID: 34734841]
Level 3 (low-level) evidenceFei YF, Lawrence AE, McCracken KA. Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review. Journal of pediatric and adolescent gynecology. 2021 Jun:34(3):328-333. doi: 10.1016/j.jpag.2020.12.002. Epub 2020 Dec 16 [PubMed PMID: 33340647]
Level 2 (mid-level) evidenceBridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Tubo-ovarian abscess. The American journal of emergency medicine. 2022 Jul:57():70-75. doi: 10.1016/j.ajem.2022.04.026. Epub 2022 Apr 27 [PubMed PMID: 35525160]
Chen CY, Lin MJ, Yang WC, Chang YJ, Gao FX, Wu HP. Clinical spectrum of intra-abdominal abscesses in children admitted to the pediatric emergency department. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2020 Apr:53(2):283-291. doi: 10.1016/j.jmii.2018.07.003. Epub 2018 Aug 9 [PubMed PMID: 30150137]
Boyko VV, Riga AS. Type 2 diabetes mellitus - IL-8 and IL-10 profile in patients with intraabdominal postoperative abscesses. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2020:73(2):220-223 [PubMed PMID: 32248148]
Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, Bartoletti M, Bassetti M, Boncagni F, Carlini M, Cattelan AM, Cavaliere A, Ceresoli M, Cipriano A, Cortegiani A, Cortese F, Cristini F, Cucinotta E, Dalfino L, De Pascale G, De Rosa FG, Falcone M, Forfori F, Fugazzola P, Gatti M, Gentile I, Ghiadoni L, Giannella M, Giarratano A, Giordano A, Girardis M, Mastroianni C, Monti G, Montori G, Palmieri M, Pani M, Paolillo C, Parini D, Parruti G, Pasero D, Pea F, Peghin M, Petrosillo N, Podda M, Rizzo C, Rossolini GM, Russo A, Scoccia L, Sganga G, Signorini L, Stefani S, Tumbarello M, Tumietto F, Valentino M, Venditti M, Viaggi B, Vivaldi F, Zaghi C, Labricciosa FM, Abu-Zidan F, Catena F, Viale P. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World journal of emergency surgery : WJES. 2024 Jun 8:19(1):23. doi: 10.1186/s13017-024-00551-w. Epub 2024 Jun 8 [PubMed PMID: 38851757]
Göbel T, Rauen-Vossloh J, Hotz HG, Boldt A, Erhardt A. [Conservative treatment of an aseptic abscess syndrome with splenic abscesses in Crohn's disease]. Zeitschrift fur Gastroenterologie. 2017 Dec:55(12):1313-1317. doi: 10.1055/s-0043-120273. Epub 2017 Dec 6 [PubMed PMID: 29212102]
Lentz J, Tobar MA, Canders CP. Perihepatic, Pulmonary, and Renal Abscesses Due to Spilled Gallstones. The Journal of emergency medicine. 2017 May:52(5):e183-e185. doi: 10.1016/j.jemermed.2016.12.016. Epub 2017 Feb 4 [PubMed PMID: 28174034]
Kim K, Kim E, Lee JH. Clinical spectrum of intra-abdominal abscesses in patients admitted to the emergency department. Australasian emergency care. 2020 Mar:23(1):6-10. doi: 10.1016/j.auec.2019.12.009. Epub 2020 Jan 8 [PubMed PMID: 31926960]
Kim SK, Ko SH, Jeong KY, Lee JS, Choi HS, Hong HP. Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess. The Journal of emergency medicine. 2021 Mar:60(3):e49-e52. doi: 10.1016/j.jemermed.2020.10.019. Epub 2020 Dec 7 [PubMed PMID: 33303274]
Alharbi O, Almadi MA, Azzam N, Aljebreen AM, AlAmeel T, Schreiber S, Mosli MH. Clinical characteristics, natural history, and outcomes of Crohn's-related intra-abdominal collections. Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 2021 Mar-Apr:27(2):79-84. doi: 10.4103/sjg.SJG_89_20. Epub [PubMed PMID: 33723092]
Capolupo GT, Mascianà G, Carannante F, Caricato M. Hepatic portal venous gas after colonoscopy: A case report and review. International journal of surgery case reports. 2018:51():54-57. doi: 10.1016/j.ijscr.2018.06.041. Epub 2018 Jul 21 [PubMed PMID: 30144710]
Level 3 (low-level) evidenceD'Souza N, Nugent K. Appendicitis. American family physician. 2016 Jan 15:93(2):142-3 [PubMed PMID: 26926413]
Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. International journal of colorectal disease. 2023 Jun 30:38(1):182. doi: 10.1007/s00384-023-04478-7. Epub 2023 Jun 30 [PubMed PMID: 37389666]
Okui J, Ueno R, Matsui H, Uegami W, Hayashi H, Miyajima T, Kusanagi H. Early prediction model of organ/space surgical site infection after elective gastrointestinal or hepatopancreatobiliary cancer surgery. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2020 Sep:26(9):916-922. doi: 10.1016/j.jiac.2020.04.009. Epub 2020 Apr 29 [PubMed PMID: 32360091]
Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. The American surgeon. 2018 Jun 1:84(6):1015-1021 [PubMed PMID: 29981641]
Zens TJ, Rogers AP, Riedesel EL, Leys CM, Ostlie DJ, Woods MA, Gill KG. The cost effectiveness and utility of a "quick MRI" for the evaluation of intra-abdominal abscess after acute appendicitis in the pediatric patient population. Journal of pediatric surgery. 2018 Jun:53(6):1168-1174. doi: 10.1016/j.jpedsurg.2018.02.078. Epub 2018 Mar 6 [PubMed PMID: 29673611]
Guizzetti L, Zou G, Khanna R, Dulai PS, Sandborn WJ, Jairath V, Feagan BG. Development of Clinical Prediction Models for Surgery and Complications in Crohn's Disease. Journal of Crohn's & colitis. 2018 Jan 24:12(2):167-177. doi: 10.1093/ecco-jcc/jjx130. Epub [PubMed PMID: 29028958]
Hannan MN, Sharma AK, Baran TM. First in human measurements of abscess cavity optical properties and methylene blue uptake prior to photodynamic therapy by in vivo diffuse reflectance spectroscopy. Journal of biomedical optics. 2024 Feb:29(2):027002. doi: 10.1117/1.JBO.29.2.027002. Epub 2024 Feb 27 [PubMed PMID: 38414658]
Ribak R, Schonman R, Sharvit M, Schreiber H, Raviv O, Klein Z. Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements. Journal of minimally invasive gynecology. 2020 Feb:27(2):541-547. doi: 10.1016/j.jmig.2019.04.027. Epub 2019 Aug 31 [PubMed PMID: 31479751]
Bakopoulos A, Tsilimigras DI, Syriga M, Koliakos N, Ntomi V, Moris D, Bistarakis D, Schizas D. Diverticulitis of the transverse colon manifesting as colocutaneous fistula. Annals of the Royal College of Surgeons of England. 2018 Aug 16:100(8):e1-e3. doi: 10.1308/rcsann.2018.0130. Epub 2018 Aug 16 [PubMed PMID: 30112933]
Yoshioka T, Kondo Y, Fujiwara T. Successful wound treatment using negative pressure wound therapy without primary closure in a patient undergoing highly contaminated abdominal surgery. Surgical case reports. 2018 Aug 1:4(1):85. doi: 10.1186/s40792-018-0493-5. Epub 2018 Aug 1 [PubMed PMID: 30069647]
Level 3 (low-level) evidenceCommander CW, Wilson SB, Bilaj F, Isaacson AJ, Burke CT, Yu H. CT-Guided Percutaneous Drainage Catheter Placement in the Abdomen and Pelvis: Predictors of Outcome and Protocol for Follow-up. Journal of vascular and interventional radiology : JVIR. 2020 Apr:31(4):667-673. doi: 10.1016/j.jvir.2019.09.026. Epub 2020 Feb 26 [PubMed PMID: 32113797]
Ukweh ON, Alswang JM, Iya-Benson JN, Naif A, Chan SM, Laage-Gaupp F, Asch M, Ramalingam V. Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience. Annals of global health. 2023:89(1):35. doi: 10.5334/aogh.4070. Epub 2023 Jun 1 [PubMed PMID: 37273489]
Level 2 (mid-level) evidenceOkita Y, Mohri Y, Kobayashi M, Araki T, Tanaka K, Inoue Y, Uchida K, Yamakado K, Takeda K, Kusunoki M. Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery. Surgery today. 2013 Oct:43(10):1095-102. doi: 10.1007/s00595-013-0504-x. Epub 2013 Feb 14 [PubMed PMID: 23408085]
Gorter RR, Meiring S, van der Lee JH, Heij HA. Intervention not always necessary in post-appendectomy abscesses in children; clinical experience in a tertiary surgical centre and an overview of the literature. European journal of pediatrics. 2016 Sep:175(9):1185-1191. doi: 10.1007/s00431-016-2756-0. Epub 2016 Aug 10 [PubMed PMID: 27511046]
Level 3 (low-level) evidenceTian Y, Yao Y, Zhou J, Diao X, Chen H, Cai K, Ma X, Wang S. Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. Frontiers in medicine. 2021:8():744907. doi: 10.3389/fmed.2021.744907. Epub 2022 Jan 26 [PubMed PMID: 35155461]
Huston JM, Barie PS, Dellinger EP, Forrester JD, Duane TM, Tessier JM, Sawyer RG, Cainzos MA, Rasa K, Chipman JG, Kao LS, Pieracci FM, Colling KP, Heffernan DS, Lester J, Therapeutics and Guidelines Committee. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surgical infections. 2024 Aug:25(6):419-435. doi: 10.1089/sur.2024.137. Epub 2024 Jul 11 [PubMed PMID: 38990709]
Bonomo RA, Chow AW, Edwards MS, Humphries R, Tamma PD, Abrahamian FM, Bessesen M, Dellinger EP, Goldstein E, Hayden MK, Kaye KS, Potoski BA, Rodríguez-Baño J, Sawyer R, Skalweit M, Snydman DR, Pahlke S, Donnelly K, Loveless J. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2024 Oct 4:79(Supplement_3):S81-S87. doi: 10.1093/cid/ciae346. Epub [PubMed PMID: 38965057]
Level 1 (high-level) evidenceHolt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). Journal of hepato-biliary-pancreatic sciences. 2015 Jan:22(1):12-5. doi: 10.1002/jhbp.150. Epub 2014 Aug 26 [PubMed PMID: 25159523]
Bufalari A, Giustozzi G, Moggi L. Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta chirurgica Belgica. 1996 Sep-Oct:96(5):197-200 [PubMed PMID: 8950379]
Level 2 (mid-level) evidenceMorita S, Kamimura K, Suda T, Oda C, Hoshi T, Kanefuji T, Yagi K, Terai S. Endoscopic ultrasound-guided transmural drainage for subphrenic abscess: report of two cases and a literature review. BMC gastroenterology. 2018 Apr 27:18(1):55. doi: 10.1186/s12876-018-0782-2. Epub 2018 Apr 27 [PubMed PMID: 29699494]
Level 3 (low-level) evidenceGutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surgical infections. 2022 Jun:23(5):417-429. doi: 10.1089/sur.2022.072. Epub 2022 May 24 [PubMed PMID: 35612434]
Level 1 (high-level) evidenceHwang JH, Kim BW, Kim SR, Kim JH. The prediction of surgical intervention in patients with tubo-ovarian abscess. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2022 Jan:42(1):97-102. doi: 10.1080/01443615.2020.1867965. Epub 2021 Feb 25 [PubMed PMID: 33629630]
Vinodhini P, Sureshkumar S, Gurushankari B, Mahalakshmy T, Kate V. Comparison of Short-Course and Conventional Antimicrobial Duration in Mild and Moderate Complicated Intra-Abdominal Infections: A randomised controlled trial. Sultan Qaboos University medical journal. 2023 May:23(2):212-219. doi: 10.18295/squmj.1.2023.006. Epub 2023 May 31 [PubMed PMID: 37377823]
Level 1 (high-level) evidenceSvetanoff WJ, Talukdar N, Dekonenko C, Dorman RM, Osuchukwu O, Fraser JD, Oyetunji TA, St Peter SD. Intra-abdominal Abscess After Appendectomy-Are Drains Necessary in All Patients? The Journal of surgical research. 2020 Oct:254():384-389. doi: 10.1016/j.jss.2020.05.016. Epub 2020 Jun 12 [PubMed PMID: 32535257]
Qian S, Vasileiou G, Pust GD, Zakrison T, Rattan R, Zielinski M, Ray-Zack M, Zeeshan M, Namias N, Yeh DD, EAST Appendicitis Study Group. Prophylactic Drainage after Appendectomy for Perforated Appendicitis in Adults: A Post Hoc Analysis of an EAST Multi-Center Study. Surgical infections. 2021 Oct:22(8):780-786. doi: 10.1089/sur.2019.258. Epub 2021 Apr 20 [PubMed PMID: 33877912]
Level 2 (mid-level) evidenceMali J, Mentula P, Leppäniemi A, Sallinen V. Determinants of treatment and outcomes of diverticular abscesses. World journal of emergency surgery : WJES. 2019:14():31. doi: 10.1186/s13017-019-0250-5. Epub 2019 Jul 8 [PubMed PMID: 31320921]
Dien Esquivel MF, Belaghi R, Webster R, Shapira-Zalstberg G. Image-guided abscess drainage in children with perforated appendicitis - can it wait? Pediatric radiology. 2023 Oct:53(11):2229-2234. doi: 10.1007/s00247-023-05726-2. Epub 2023 Aug 9 [PubMed PMID: 37553458]
Moreno-Alfonso JC, Molina Caballero A, Pérez Martínez A. Antibiotic treatment of post-appendectomy abscesses in children, regardless of size: a twelve years' experience. Updates in surgery. 2023 Dec:75(8):2267-2272. doi: 10.1007/s13304-023-01654-w. Epub 2023 Oct 4 [PubMed PMID: 37794218]
Arezzo A, Nicotera A, Bonomo LD, Olandese F, Veglia S, Ferguglia A, Pentassuglia G, Mingrone G, Morino M. Outcomes of surgical treatment of diverticular abscesses after failure of antibiotic therapy. Updates in surgery. 2023 Jun:75(4):855-862. doi: 10.1007/s13304-023-01509-4. Epub 2023 Apr 24 [PubMed PMID: 37093495]
Ocaña J, García-Pérez JC, Fernández-Martínez D, Aguirre I, Pascual I, Lora P, Espin E, Labalde-Martínez M, León C, Pastor-Peinado P, López-Domínguez C, Muñoz-Plaza N, Valle A, Dujovne P, Alías D, Pérez-Santiago L, Correa A, Carmona M, Díez MM, Timoteo A, Salvans S, Medina RE, Gómez T, Fernández-Vega L, Peña E, García-González JM, Blanco-Antona F, Fábregues AI, Sagarra E, Viejo E, Moreno A, Fernández-Cebrián JM, Die J, DIPLICAB Study Collaborative Group. Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. Surgery. 2023 Sep:174(3):492-501. doi: 10.1016/j.surg.2023.05.016. Epub 2023 Jun 27 [PubMed PMID: 37385866]
Collard MK, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corté H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche R, Vicaut E, Panis Y, Brouquet A. A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort. Journal of Crohn's & colitis. 2021 Mar 5:15(3):409-418. doi: 10.1093/ecco-jcc/jjaa217. Epub [PubMed PMID: 33090205]
Sun Y, Liu W, Ma Y, Yang H, Li Y, Tan B, Li J, Qian J. Computerized tomography features acting as predictors for invasive therapy in the management of Crohn's disease-related spontaneous intra-abdominal abscess: experience from long-term follow-up. BMC medical imaging. 2024 Nov 5:24(1):300. doi: 10.1186/s12880-024-01475-2. Epub 2024 Nov 5 [PubMed PMID: 39501173]
Level 2 (mid-level) evidencePerl D, Waljee AK, Bishu S, Higgins PDR, Wasnik AP, Stidham RW. Imaging Features Associated With Failure of Nonoperative Management of Intraabdominal Abscesses in Crohn Disease. Inflammatory bowel diseases. 2019 Nov 14:25(12):1939-1944. doi: 10.1093/ibd/izz069. Epub [PubMed PMID: 31294779]
Celentano V, Giglio MC, Pellino G, Rottoli M, Sampietro G, Spinelli A, Selvaggi F, Italian Society of Colorectal Surgery SICCR. High complication rate in Crohn's disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study. International journal of colorectal disease. 2022 Jun:37(6):1421-1428. doi: 10.1007/s00384-022-04183-x. Epub 2022 May 23 [PubMed PMID: 35599268]
El-Hussuna A, Karer MLM, Uldall Nielsen NN, Mujukian A, Fleshner PR, Iesalnieks I, Horesh N, Kopylov U, Jacoby H, Al-Qaisi HM, Colombo F, Sampietro GM, Marino MV, Ellebæk M, Steenholdt C, Sørensen N, Celentano V, Ladwa N, Warusavitarne J, Pellino G, Zeb A, Di Candido F, Hurtado-Pardo L, Frasson M, Kunovsky L, Yalcinkaya A, Tatar OC, Alonso S, Pera M, Granero AG, Rodríguez CA, Minaya A, Spinelli A, Qvist N. Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease. BJS open. 2021 Sep 6:5(5):. doi: 10.1093/bjsopen/zrab075. Epub [PubMed PMID: 34518869]
Yuan Y, Tang Y, Liu Y, Ren P. A Low Prognostic Nutritional Index Level, an Independent Predictor for Postoperative Intra-abdominal Abscess After Laparoscopic Appendectomy. Surgical laparoscopy, endoscopy & percutaneous techniques. 2024 Dec 1:34(6):603-606. doi: 10.1097/SLE.0000000000001328. Epub 2024 Dec 1 [PubMed PMID: 39358825]
Smith AA, Cone JT, McNickle AG, Mitchao DP, Kostka R, Martinez B, Schroeppel T, Cavalea A, Shahan CP, Axtman B, Braverman MA, Multi-Institutional Trial Liver Study Group. MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma. The Journal of surgical research. 2024 Mar:295():746-752. doi: 10.1016/j.jss.2023.11.010. Epub 2023 Dec 25 [PubMed PMID: 38147760]
Level 2 (mid-level) evidenceFarvacque G, Guilbaud T, Loundou AD, Scemamma U, Berdah SV, Moutardier V, Chirica M, Risse O, Girard E, Birnbaum DJ. Delayed post-pancreatectomy hemorrhage and bleeding recurrence after percutaneous endovascular treatment: risk factors from a bi-centric study of 307 consecutive patients. Langenbeck's archives of surgery. 2021 Sep:406(6):1893-1902. doi: 10.1007/s00423-021-02146-4. Epub 2021 Mar 24 [PubMed PMID: 33758966]
Zheng S, Christy K, Herzak K, Kobal N, Novak M, Young J, Miyasaka E. Labs Do Not Predict Postoperative Intra-abdominal Abscess in Pediatric Perforated Appendicitis. The Journal of surgical research. 2023 May:285():20-25. doi: 10.1016/j.jss.2022.12.015. Epub 2023 Jan 11 [PubMed PMID: 36638551]
Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, Rickard J, Zheng B, Liu H, Shi Q, Zhao S, Wang Z, Liu X, Luo Z, Yang K, Chen Y, Sawyer RG. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World journal of emergency surgery : WJES. 2023 Mar 29:18(1):24. doi: 10.1186/s13017-023-00496-6. Epub 2023 Mar 29 [PubMed PMID: 36991507]
Level 1 (high-level) evidenceJen J, Hwang R, Mattei P. Post-discharge antibiotics do not prevent intra-abdominal abscesses after appendectomy in children. Journal of pediatric surgery. 2023 Feb:58(2):258-262. doi: 10.1016/j.jpedsurg.2022.10.024. Epub 2022 Oct 29 [PubMed PMID: 36428182]
Muñoz-Serrano AJ, Delgado-Miguel C, Núñez Cerezo V, Barrena Delfa S, Velayos M, Estefanía-Fernández K, Miguel Ferrero M, Martínez L. Does time to antibiotic initiation and surgery have an impact on acute appendicitis results? Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica. 2020 Apr 1:33(2):65-70 [PubMed PMID: 32250068]
Podda M, Ceresoli M, Di Martino M, Ortenzi M, Pellino G, Pata F, Ielpo B, Murzi V, Balla A, Lepiane P, Tamini N, De Carlo G, Davolio A, Di Saverio S, Cardinali L, Botteri E, Vettoretto N, Gelera PP, De Simone B, Grasso A, Clementi M, Meloni D, Poillucci G, Favi F, Rizzo R, Montori G, Procida G, Recchia I, Agresta F, Virdis F, Cioffi SPB, Pellegrini M, Sartelli M, Coccolini F, Catena F, Pisanu A. Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study. Surgical endoscopy. 2024 Jun:38(6):3180-3194. doi: 10.1007/s00464-024-10793-z. Epub 2024 Apr 17 [PubMed PMID: 38632117]
Level 2 (mid-level) evidenceFrediani S, Aloi IP, Krzysztofiak A, D'Angelo T, Bertocchini A, Madafferi S, Accinni A, Pardi V, Inserra A. The Intraperitoneal Use of Cephazolin: A Novelty in the Prevention of Intra-abdominal Abscess after Laparoscopic Appendectomy in Children. Annali italiani di chirurgia. 2024:95(2):253-256. doi: 10.62713/aic.3381. Epub [PubMed PMID: 38684488]
Wee JJ, Park CJ, Lee YT, Cheong YL, Rai R, Nah SA. A simple classification of peritoneal contamination in perforated appendicitis predicts surgery-related complications. Journal of paediatrics and child health. 2020 Feb:56(2):272-275. doi: 10.1111/jpc.14591. Epub 2019 Aug 13 [PubMed PMID: 31410904]
Araim F, Shmelev A, Kowdley GC. Incidence of Complicated Appendicitis as a Metric of Health Care Delivery. The American surgeon. 2022 Apr:88(4):597-607. doi: 10.1177/0003134820953769. Epub 2020 Nov 27 [PubMed PMID: 33242987]
Vaghiri S, David SO, Sultani AB, Safi SA, Knoefel WT, Prassas D. Clinical relevance of the 3-cm threshold in sigmoid diverticulitis with abscess: consensus or quandary? International journal of colorectal disease. 2024 Jul 12:39(1):106. doi: 10.1007/s00384-024-04682-z. Epub 2024 Jul 12 [PubMed PMID: 38995320]
Level 3 (low-level) evidenceSueda T, Tei M, Yoshikawa Y, Furukawa H, Matsumura T, Koga C, Wakasugi M, Miyagaki H, Kawabata R, Tsujie M, Hasegawa J. Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis. International journal of colorectal disease. 2020 Mar:35(3):413-422. doi: 10.1007/s00384-019-03493-x. Epub 2020 Jan 2 [PubMed PMID: 31897647]
Okui J, Obara H, Uno S, Sato Y, Shimane G, Takeuchi M, Kawakubo H, Kitago M, Okabayashi K, Kitagawa Y. Adverse effects of long-term drain placement and the importance of direct aspiration: a retrospective cohort study. The Journal of hospital infection. 2023 Jan:131():156-163. doi: 10.1016/j.jhin.2022.10.010. Epub 2022 Nov 9 [PubMed PMID: 36370963]
Level 2 (mid-level) evidenceHu A, Li J, Vacek J, Bouchard M, Ingram MC, McMahon M, Mithal LB, Raval MV, Reynolds M, Goldstein S. Antibiotic resistance is common in the cultures of intraabdominal abscess drainage after appendectomy. Journal of pediatric surgery. 2022 Sep:57(9):102-106. doi: 10.1016/j.jpedsurg.2021.12.003. Epub 2021 Dec 9 [PubMed PMID: 34991867]
Byerly SE, Filiberto DM, Lenart EK, Easterday T, Howley I, Nouer S, Tolley E, Magnotti LJ. Clinical decompensation after trauma laparotomy: It's probably not a pulmonary embolus. Injury. 2024 Sep:55(9):111651. doi: 10.1016/j.injury.2024.111651. Epub 2024 Jun 3 [PubMed PMID: 38849214]
Lorente-Herce JM, Parra-Membrives P, Martínez-Baena D, Cañete-Gómez J, Segura-Sampedro JJ. Influence of surgical site infection on oncological prognosis after curative resection for colorectal cancer: An observational single-institution study. Cirugia y cirujanos. 2021:89(5):574-582. doi: 10.24875/CIRU.20000603. Epub [PubMed PMID: 34665164]
Vaghiri S, Prassas D, Mustafov O, Kalmuk S, Knoefel WT, Lehwald-Tywuschik N, Alexander A, Dizdar L. Which factors predict tumor recurrence and survival after curative hepatectomy in hepatocellular carcinoma? Results from a European institution. BMC surgery. 2024 Apr 8:24(1):101. doi: 10.1186/s12893-024-02399-y. Epub 2024 Apr 8 [PubMed PMID: 38589847]
Matsui R, Inaki N, Tsuji T, Fukunaga T. Relationship Between Fat Mass Indices and Postoperative Complications After Laparoscopic Gastrectomy in Patients With Gastric Cancer: A Propensity Score Matching Analysis. Anticancer research. 2022 Oct:42(10):4841-4848. doi: 10.21873/anticanres.15989. Epub [PubMed PMID: 36191993]
Kolck J, Hosse C, Beetz NL, Auer TA, Marth AA, Segger L, Krenzien F, Lurje G, Pelzer U, Geisel D, Schöning W, Fehrenbach U. Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients. Cancer reports (Hoboken, N.J.). 2024 Sep:7(9):e2070. doi: 10.1002/cnr2.2070. Epub [PubMed PMID: 39324689]
Wang H, Jin J, Zhu F, Peng F, Wang M, Qin R. The ratio of abdominal depth to body mass index is a preoperative predictor of postoperative complications after laparoscopic pancreaticoduodenectomy: a retrospective propensity score matched analysis. Surgical endoscopy. 2021 Dec:35(12):6472-6480. doi: 10.1007/s00464-020-08140-z. Epub 2020 Nov 6 [PubMed PMID: 33156385]
Level 2 (mid-level) evidenceFurukawa A, Furukawa K, Suzuki D, Yoshitomi H, Takayashiki T, Kuboki S, Miyazaki M, Ohtsuka M. Effect of immunonutrition on infectious complications in low skeletal muscle mass patients after pancreaticoduodenectomy. Clinical nutrition (Edinburgh, Scotland). 2021 Jan:40(1):103-109. doi: 10.1016/j.clnu.2020.04.032. Epub 2020 Apr 28 [PubMed PMID: 32402682]
Yamamoto T, Nakahigashi M, Shimoyama T, Umegae S. Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn's disease? A case-matched study. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2020 May:22(5):554-561. doi: 10.1111/codi.14922. Epub 2019 Dec 22 [PubMed PMID: 31782874]
Level 3 (low-level) evidenceJeong O, Jang A, Jung MR, Kang JH, Ryu SY. The benefits of enhanced recovery after surgery for gastric cancer: A large before-and-after propensity score matching study. Clinical nutrition (Edinburgh, Scotland). 2021 Apr:40(4):2162-2168. doi: 10.1016/j.clnu.2020.09.042. Epub 2020 Oct 1 [PubMed PMID: 33069509]
Fukuhara S, Kobayashi T, Hamaoka M, Naruhiko H, Oishi K, Namba Y, Oshita KO, Matsubara K, Takei D, Nakano R, Sakai H, Kuroda S, Tahara H, Ohira M, Ohdan H. Sarcopenia's Impact Defined by Grip Strength and Muscle Mass on Post-hepatectomy Outcomes: A Multicenter Analysis. In vivo (Athens, Greece). 2024 Nov-Dec:38(6):2827-2835. doi: 10.21873/invivo.13763. Epub [PubMed PMID: 39477404]
Holubar SD, Hedrick T, Gupta R, Kellum J, Hamilton M, Gan TJ, Mythen MG, Shaw AD, Miller TE, Perioperative Quality Initiative (POQI) I Workgroup. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery. Perioperative medicine (London, England). 2017:6():4. doi: 10.1186/s13741-017-0059-2. Epub 2017 Mar 3 [PubMed PMID: 28270910]
Level 2 (mid-level) evidenceSeifarth C, Kreis ME, Gröne J. Indications and Specific Surgical Techniques in Crohn's Disease. Viszeralmedizin. 2015 Aug:31(4):273-9. doi: 10.1159/000438955. Epub 2015 Aug 14 [PubMed PMID: 26557836]
Zani A, Hall NJ, Rahman A, Morini F, Pini Prato A, Friedmacher F, Koivusalo A, van Heurn E, Pierro A. European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 2019 Feb:29(1):53-61. doi: 10.1055/s-0038-1668139. Epub 2018 Aug 15 [PubMed PMID: 30112745]
Level 3 (low-level) evidence