Intraperitoneal Spread of Infections

A remarkable change in the epidemiology of subphrenic and subhepatic abscesses has occurred over the past several decades. In the past, the most common causes included perforations of anterior gastric or duodenal ulcers and rupture of a gangrenous appendix. Today, 6071% of such abscesses are postoperative and are particularly frequent following gastric and biliary tract operations and colonic surgery. 1-3 Many of the cases of postoperative abscesses are secondary to anastomotic leaks.4 More prompt diagnosis currently in conditions such as peptic ulcer and appendicitis, leading to earlier surgical intervention, results in an increasing proportion of postoperative abscesses. The bacterial flora generally consist of multiple strains of aerobic and anaerobic organisms. The aerobes include particularly Escherichia coli, Streptococcus, Klebsiella, and Proteus; the anaerobes, Bac-teroides and cocci.2

Paralleling this epidemiologic change has been a change in the clinical presentation. The fulminating course described classically is no longer generally seen, and today abscesses most often present in an insidious fashion, typically consisting of mild abdominal pain, malaise, and a slight fever. Later, the patient may develop a mass, referred pain to the shoulder, and subcostal or flank pain. The clinical spectrum is illustrated by this analogy:

It can rapidly build up a crater of sepsis giving the patient an acute illness with a clear cut diagnosis ... on the other hand, it may linger apparently quiescent, causing only a slight fever, only to erupt unexpectedly some weeks or months later. Finally, it may be like Vesuvius, apparently extinct, apart from occasional rumbles, making its presence felt only by causing ill health.

Early radiologic identification and localization of an intraabdominal abscess are of extreme importance, since morbidity and mortality increase with delay in treatment. Diagnosis can be most prompt and accurate when there is an understanding of the intraperitoneal routes of spread of contaminated material.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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