The clinical presentation is varied and depends on the location of the abscess in the intraabdominal cavity. Vague abdominal discomfort is common, and pain may localize to a site of intraabdominal inflammation (in the patient with diverticulitis, for example). Fever and leukocytosis are also seen. The clinician should be mindful that patients who are immunosuppressed may have very mild and nonspecific symptoms. Patients who have a spinal cord injury or altered mental status may be similarly difficult to diagnose.
Patients who suffer from diverticulitis, inflammatory bowel disease (eg, ulcerative colitis, Crohn disease), or conditions that may lead to intestinal obstruction and subsequent perforation are at risk for intraabdominal abscesses. Also, patients who have penetrating trauma to the abdomen or undergo a surgical procedure involving intraabdominal or pelvic organs are at risk for this condition.
K65.1 – Peritoneal abscess
75100008 – Abdominal abscess
- Appendicitis – usually presents with prominent right lower quadrant pain
- Cholecystitis – usually presents with prominent right upper quadrant pain
- Diverticulitis – the pain is usually located in the left lower quadrant
- Pancreatitis – the pain is usually epigastric with radiation to the back
- Peptic ulcers – the pain is usually epigastric
- Inflammatory bowel disease (eg, ulcerative colitis, Crohn disease) – abdominal pain usually associated with diarrhea
- Pelvic inflammatory disease – patients have cervical motion tenderness
- Nephrolithiasis – pain often radiates to groin and does not usually cause fever unless the stone causes obstruction and there is a urinary tract infection
- Infectious diarrhea, including Clostridium difficile colitis
- Pyelonephritis – Costovertebral angle tenderness is usually more prominent than abdominal pain. Patients with renal transplant may have abdominal pain localized over the allograft.
- Typhlitis – usually presents with right lower quadrant abdominal pain in neutropenic patients