REAPPRAISAL OF THE PROBLEMS OF INTRA-ABDOMINAL ABSCESS

Abstract

During a 10 yr period, 69 patients underwent 100 operations for > 147 intraabdominal abscesses. The overall mortality was 24.6% and the redrainage rate, 30.4%. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored 2 or more different organisms. Mortalities were low in patients < 20 yr of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients > 40 yr of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intraabdominal abscess are confirmed.