2 Summary Abdominal abscess refers to the limited accumulation of pus in a certain gap or part of the abdominal cavity due to tissue necrosis and liquefaction, and it is wrapped by intestinal curvature, viscera, abdominal wall, omentum or mesentery. Include subphrenic abscess, pelvic abscess and intestinal abscess. Various diseases that cause secondary peritonitis, abdominal surgery and trauma can all cause this disease.
3 diagnosis 1. In addition to clinical manifestations, the diagnosis of septal abscess usually needs to be confirmed by auxiliary examination techniques. B-ultrasound is the most commonly used, and the correct diagnosis rate can reach about 90%.
Upper abdominal X-ray and gastrointestinal barium meal examination are helpful to determine the location of abscess. Because 10 ~ 25% of the pus cavity contains gas, the gas-liquid plane can be seen. Other X-ray signs include gastrointestinal tract displacement, foreign body impression, diaphragm elevation and blurred costal diaphragm angle, reactive pleural effusion, etc.
The accuracy of CT diagnosis is over 90%, which can determine the location and scope of abscess and its relationship with adjacent organs.
B superconducting diagnostic puncture is the simplest diagnostic method for subphrenic abscess. If necessary, a tube can be placed for drainage.
Second, pelvic abscess: married women can still have pelvic examination to distinguish pelvic inflammatory mass or abscess. Pelvic ultrasound is helpful for diagnosis. Diagnosis can be made by aspiration of pus through rectum or posterior fornix after bladder emptying.
3. Intestinal abscess: Abdominal X-ray film can show widening of intestinal wall space and local pneumoperitoneum. B-mode ultrasound, especially computed tomography, can determine the location and scope of abscess.
Treatment measures 1. Treatment of subphrenic abscess: In the treatment of peritonitis, the formation of subphrenic abscess can be effectively prevented by adopting semi-recumbent position, reasonably selecting antibiotics, carefully stopping bleeding and placing drainage after gastrectomy. Even in the early stage of subphrenic abscess formation, inflammation can be subsided and absorbed by antibiotics and supportive therapy. However, after several weeks of treatment, if the fever persists and the patient is weak, it is still appropriate to drain in time.
Ultrasound-guided puncture and drainage is a simple and effective treatment for subphrenic abscess with deep position, small abscess cavity and thin pus. The key to success lies in choosing the appropriate puncture path and the necessity of catheter irrigation and drainage.
Surgical drainage is still suitable for patients with large abscess cavity, thick abscess wall or multilocular abscess.
1. Transabdominal anterior wall approach? Most commonly used. Methods Oblique incision was made under the costal margin, and the incision was made layer by layer. When you see the peritoneum, you can drain the abscess in the space between the right upper liver and the left upper liver. Because there is adhesion around the abscess, the peritoneum can also be opened to drain the abscess between the left and right liver spaces. After the abscess cavity is cut, the pus is sucked out and put into silicone tube or double cannula for drainage.
2. Through the lumbar posterior approach? Cut along the 12 rib, expose and take out the 12 rib, and cut the rib bed horizontally at the first lumbar plane. Be careful not to cut along the bone bed to avoid damaging the pleura. After the rib bed is cut, it enters the peritoneum, and the kidney is pushed down, which can drain the subphrenic abscess under the right liver, behind the left diaphragm and in the extraperitoneal space.
3. Through the chest wall incision? It should be carried out in two stages. In the first stage, an incision was made at the eighth or ninth rib of the chest side wall, and some ribs were removed to the outside of the pleura. The wound was filled with iodine gauze to make the pleura adhere to the diaphragm, and the second stage operation was performed after about 5 ~ 7 days. Puncture the adhered pleura and diaphragm through the original incision, and then cut the pleura and diaphragm along the direction of the puncture needle to place drainage. It is suitable for drainage of high abscess in upper right hepatic space.
Second, the treatment of pelvic abscess: cut the anterior wall or posterior fornix of rectum, put in soft silicone tube for drainage, and pull out the catheter 3 ~ 4 days after operation. Continue to use antibiotics, hot water bath, social physical therapy and other treatment measures to promote inflammation regression and absorption.
Third, intestinal abscess: multiple small abscesses can often be absorbed by themselves after antibiotic treatment. Larger abscesses need laparotomy, drainage of pus, removal of pus wall, washing with a large amount of physiological saline or antibiotic solution, and generally no drainage.
Etiology Subphrenic abscess is often secondary to abdominal organ perforation and inflammation, such as acute appendicitis perforation, gastroduodenal ulcer perforation, liver abscess perforation, etc., which often causes right subphrenic abscess, while infection occurs after gastrectomy and splenectomy, and hemorrhagic necrotizing pancreatitis often causes left subphrenic abscess. Most pathogenic bacteria come from the gastrointestinal tract, and they are often mixed with Escherichia coli, Streptococcus, Klebsiella pneumoniae and anaerobic bacteria. Staphylococcus, Streptococcus and Pneumococcus are the main infections that spread from purulent chest diseases to diaphragm.
Inflammatory exudate or pus in abdominal cavity is easy to accumulate in pelvic cavity and form abscess. The most common causes are appendicitis perforation and pelvic peritonitis caused by female reproductive tract infection.
6 clinical manifestations: subphrenic abscess: after the treatment of inflammatory lesions in abdominal organs, or after gastrectomy and splenectomy, the body temperature dropped, and then the body temperature rose again, so the possibility of subphrenic infection should be considered. The main symptom of the patient is relaxation fever, which is around 39℃, accompanied by a lot of poisoning symptoms, such as sweating, anorexia, fatigue and general malaise. Persistent dull pain in the upper abdomen of the affected side can radiate to the shoulder and back, which is aggravated when taking a deep breath or coughing, and sometimes accompanied by hiccups. During physical examination, there was deep tenderness and percussion pain in the upper abdomen or back of the affected side, and local skin edema appeared in severe cases. Due to reactive inflammation and pleural effusion, the respiratory sound at the base of the affected muscle weakened or disappeared, and even wet rales could be heard. White blood cell count and neutrophil ratio increased.
Pelvic abscess: the pelvic peritoneum is small in area and has poor ability to absorb toxins. Therefore, the symptoms of pelvic abscess are mild, but the local symptoms are relatively obvious. In the process of peritonitis, or after pelvic surgery, occupational flaccid fever does not subside, or rises again after falling, and rectal and bladder signs appear, so we should think of the formation of pelvic abscess. It is characterized by abdominal discomfort, abdominal urgency, frequent defecation and mucus in feces; Frequent urination, urgency, and even dysuria. The rectal digital examination can find that the sphincter of anal canal is slack and the anterior wall of rectum is swollen and tender.
Intestinal abscess: after peritonitis, pus is wrapped by intestine, mesentery and omentum, which can form one or more abscesses of different sizes. It is characterized by low fever and dull abdominal pain. A large abscess can palpate a painful lump and may be accompanied by symptoms of systemic poisoning. Intestinal adhesion caused by inflammation can sometimes cause incomplete intestinal obstruction symptoms such as intestinal chicken, abdominal pain and abdominal distension.
Acupoints for treating abdominal abscess: If there is pus or urgency in the pelvic cavity, you should go to the hospital immediately to prevent the pelvic abscess from festering the intestinal wall and causing acute peritonitis. 7. Some patients suffer from chronic diseases. ...
Hole mouth: Abdominal surgery was performed on rabbits, and the diameter change of abdominal artery in rabbits was directly observed by stereomicroscope. The "hole mouth" was electroacupuncture on rabbits. Results After electroacupuncture, the vascular orifice was observed. ...
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