Appendicitis abscess

The causes of intraabdominal abscess overlap those of peritonitis and, in fact, may occur sequentially or simultaneously. Appendicitis is the most frequent cause of abscess. 

An abscess occurs if peritoneal contamination is localized but bacterial elimination is incomplete. The location of the abscess often is related to the site of primary disease. For example, abscesses resulting from appendicitis tend to appear in the right lower quadrant or the pelvis those resulting from diverticulitis tend to appear in the left lower quadrant or pelvis. A mature abscess may have a fibrinous capsule that isolates bacteria and the liquid core from antimicrobials and immunologic defenses. 

Signs and Symptoms Symptoms include pain in the lower-right abdominal area resembling appendicitis, as well as fever, headache, pharyngitis, anorexia, vomiting, and possibly watery diarrhea. May also produce arthritis, inflammation of the iris (iritis), cutaneous ulceration. Infection may also produce abscesses in the liver, bone infection (osteomyelitis), and septicemia. Carriers may be asymptomatic. May also cause infections of other sites such as wounds, joints, and the urinary tract. 

Table 42-1 summarizes many of the potential causes of bacterial peritonitis. The causes of intraabdominal abscess somewhat overlap those of peritonitis and, in fact, both may occur sequentially or simultaneously. Appendicitis is the most frequent cause of abscess. Intraabdominal infection results from entry of bacteria into the peritoneal or retroperitoneal spaces or from bacterial collections within intraabdominal organs. When peritonitis results from peritoneal dialysis, skin surface flora are introduced via the peritoneal catheter. 

Acute appendicitis without evidence of gangrene, perforation, abscess, or peritonitis requires only prophylactic administration of inexpensive regimens active against facultative and obligate anaerobes. 

Chi Shao Yao is sour, bitter and slightly cold. It is characterized by reducing the excess heat in the blood and regulating the blood circulation. It can also reduce swelling and pain and is often used in formulas to treat abscesses, furunculosis, appendicitis, intestinal obstruction and dysmenorrhea. It can be used topically to treat pain and swelling due to trauma. 

Povidone-iodine reduced the number of wound infections only in patients with appendicitis in whom neither peritonitis nor a periappendicular abscess had yet developed (SED-11, 489). 

Amoebiasis is marked by two phases of the infection (a) intestinal amoebiasis characterised by dysentery and diarrhea, nondysenteric colitis, amoeboma (amoebic granuloma) and amoebic appendicitis and (b) extraintestinal amoebiasis (hepatic amoebiasis) marked by liver abscess [48],... 

Fig. 1. 61a-d. Perforated appendicitis phlegmon and abscess. a,b Phlegmon. Inflammatory mass composed of a complex fluid collection (C), prominent mesenteric fat (M), and adjacent thickened poorly defined intestinal bowel loops (B) just close to the appendiceal remnants (arrows). c,d Abscesses. Distant multiple abscesses in the pouch of Douglas and in the subhepatic region. A, abscess... 

Fig. 1.65a-c. CT in appendicitis. A 13-year-old girl treated with antibiotics for pelvic pain and fever, a US shows a non-specific cystic mass (M) cranial to the uterus (U). No flow was observed on color Doppler study. b,c CT clearly demonstrates the close relationship between the mass (A) and the enlarged appendix (arrow) with an appendicolith (arrowhead). An appendiceal abscess was demonstrated at surgery. B, Bladder A, abscess... 

The differential diagnosis includes appendicitis with an appendicular abscess, inflammatory bowel disease or leukaemic deposit (in which case the wall thickening is likely to be eccentric) (Alexander et al. 1988) (Fig. 6.14). 

In the majority of cases, tuboovarian abscesses (TOA) result from pelvic inflammatory disease. It is reported to complicate PID in up to one-third of patients hospitalized for treatment [6]. Other etiologies include complications of surgery or intra-abdominal inflammatory bowel diseases, such as appendicitis, diverticulitis, or Crohn disease. In most cases, TOA is caused by a polymicrobial infection with a high prevalence of anaerobes. lUD users, especially in the first few months after insertion, are also under a higher risk of PID. Pelvic actinomycosis is considered to be highly associated with the use of lUD [1]. 

Clinically, ruptured ovarian cysts may resemble ovarian torsion. In a patient with acute pelvic pain, a hemorrhagic lesion within a normal size ovary is typically a ruptured ovarian cyst. Furthermore, unlike in most cases of ovarian torsion, clotted blood may be detected in the lesser pelvis. Wall edema of an adnexal mass, engorged adnexal vessels or dilatation of the fallopian tube are missing. TUboovarian abscess and hydrosalpinx may resemble advanced adnexal torsion. Lack of enhancement supports the diagnosis of ovarian torsion. In children, sonography usually allows the diagnosis of appendicitis as a cause of acute pelvic pain. In case of a suspected abscess or an ovarian mass, MRI may aid in further assessment of the adnexa. Rarely, a calcified mass may result from chronic infarction which cannot reliably be differentiated from a calcified ovarian tumor [19]. 

Perforation and abscess formation complicated appendicitis in 38%-55%, with the highest rates occurring in children and in elderly patients. 

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