Differential Diagnosis of Intra-abdominal Abscess: A Comprehensive Guide for Auto Repair Experts

Introduction

Intra-abdominal abscesses, localized collections of pus within the abdomen, pose significant diagnostic challenges. As experts in auto repair at xentrydiagnosis.store, we understand the complexities of differential diagnosis – the process of distinguishing between diseases with similar symptoms. In the context of intra-abdominal abscesses, this process is crucial to differentiate this condition from other abdominal pathologies that may present with overlapping clinical signs. Accurate and timely Differential Diagnosis Abscess is paramount for effective management and to prevent potentially life-threatening complications. These abscesses, often arising from infections, surgical aftereffects, or trauma, demand a high degree of clinical suspicion and advanced imaging techniques like CT scans for definitive diagnosis. Left unaddressed, they can lead to substantial illness and even death. Effective treatment strategies involve antibiotics, drainage procedures, and, in certain instances, surgical intervention. Factors such as pre-existing health conditions, delays in diagnosis, and antibiotic resistance can further complicate patient outcomes, underscoring the necessity of a structured, multidisciplinary approach to patient care.

This article provides an in-depth exploration of the differential diagnosis abscess within the abdomen, focusing on its pathophysiology, clinical presentation, and diagnostic modalities. We will highlight conditions that mimic intra-abdominal abscesses, ensuring a robust understanding for accurate clinical decision-making. This comprehensive review aims to equip clinicians with the knowledge to refine their differential diagnosis abscess skills, enhance patient care strategies, and improve overall clinical outcomes in managing this complex condition.

Etiology of Intra-abdominal Abscess

Understanding the diverse causes of intra-abdominal abscesses is fundamental in developing an effective differential diagnosis abscess. These causes are broadly classified into several categories: inflammatory, infectious, malignant, traumatic, and iatrogenic. Abscesses can originate within the abdominal cavity itself, stem from an intra-abdominal organ, or even spread from sources outside the abdomen. While various unusual sources are documented in case reports, the majority of intra-abdominal abscesses harbor colonic flora. The specific types of microbes present are influenced by geographic location and the patient’s overall health status.

Common sources of intra-abdominal abscesses include diverticulitis, perforated ulcers, appendicitis, gangrenous cholecystitis, bowel infarction, splenic infarcts or infections, inflammatory bowel disease, trauma, anastomotic leaks, and contamination during surgery. Systemic infections can also lead to abscess formation, including rare instances of echinococcosis or amebiasis, in both adults and children. Periodontal disease is also recognized as a potential source of bacterial dissemination that can result in abscesses. Foreign materials, such as peritoneal dialysis catheters or inadvertently retained surgical objects, can also trigger intra-abdominal abscesses. Splenic abscesses secondary to endocarditis, though rare, are clinically significant. Individuals with Crohn’s disease may develop abscesses spontaneously, and cases link familial adenomatous polyposis with desmoid tumors complicated by abscesses. Postoperative abscesses have been reported due to dropped gallstones, and less commonly, appendicoliths. Rare causes include abscesses associated with colonic mucosa-associated lymphoid tissue lymphoma. Furthermore, an intra-abdominal process may, in rare cases, lead to abscesses in distant locations, such as a sigmoid diverticular perforation resulting in a left inguinal abscess.

The microbial composition of intra-abdominal abscesses typically includes colonic flora, with prevalent organisms such as Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter, Streptococci, Enterococci, Neisseria, and various anaerobic bacteria, including Bacteroides, Clostridium, and Chlamydia trachomatis. Coliform bacteria often dominate the early stages of abscess formation, while anaerobes become more prominent in later stages. Candida species have been found in infections originating from the gastrointestinal tract, particularly in patients on prior antibiotics, with recurrent infections, or those with compromised immune systems. Hospital-acquired intra-abdominal infections are often caused by nosocomial pathogens, such as Pseudomonas aeruginosa and other drug-resistant organisms.

Postoperative abscesses are frequently encountered, with approximately 70% of intra-abdominal abscesses occurring after surgery. About 6% of patients undergoing colorectal surgery develop postoperative abscesses. Hepatic abscesses constitute around 13% of all intra-abdominal abscesses, predominantly in the right lobe, possibly due to its larger size and greater blood supply. Prediction models exist to assess risk factors for postoperative complications. Studies have indicated that bile contamination during pancreaticoduodenectomy and elevated postoperative C-reactive protein (CRP) levels are associated with a higher incidence of intra-abdominal abscesses.

Sterile abscess collections can also occur. Transabdominal injections may occasionally lead to sterile intra-abdominal abscesses. Aseptic abscess syndrome, though rare, is a recognized complication in inflammatory bowel disease and may sometimes be the initial indicator of the condition. Cultures from these abscesses are sterile. Often misdiagnosed and treated with ineffective antibiotics, these collections respond well to immunosuppressive therapy, such as high-dose intravenous steroids. Intra-abdominal infections can also spread to extra-abdominal sites. Cases of colorectal perforations presenting as thigh abscesses have been reported, often with delayed diagnosis and significant complications. Tubo-ovarian abscesses, which can affect both young and adult women, can have serious clinical consequences and may originate from gynecologic or gastrointestinal sources.

Epidemiology of Intra-abdominal Abscess

Intra-abdominal abscesses are a relatively common clinical issue with significant consequences for patient health and survival. Over 60% are acquired in hospitals, underscoring the substantial impact of healthcare-associated infections on their occurrence. Hospital-acquired abscesses are more likely to result in severe complications, including sepsis and multi-organ failure, often requiring intensive care. Delays in diagnosis, antibiotic resistance, and coexisting medical conditions substantially increase mortality rates in these patients.

Appendicitis and diverticulitis are among the most frequent underlying causes of intra-abdominal abscesses, posing the greatest risk. A study involving 243 cases highlighted appendicitis as the leading cause, followed by diverticulitis. Polymicrobial infections were common, found in nearly 82% of cases. The study identified 428 microorganisms, predominantly bacteria but also including Candida species. Escherichia coli and Bacteroides fragilis were the most frequently identified pathogens in community-acquired infections, whereas hospital-acquired cases showed a higher incidence of Enterococcus faecium. The distribution of bacteria also varied by location within the abdomen. E. coli and B. fragilis were more common in submesocolic abscesses, while Candida species were more prevalent in supramesocolic infections. Resistance to antibiotics like cefotaxime-metronidazole was more pronounced in hospital-acquired infections, likely due to the higher proportion of enterococci in these settings.

Pediatric cases offer unique epidemiological insights. A study of 66 children with intra-abdominal abscesses revealed that over 80% presented with elevated white blood cell counts (leukocytosis) and increased CRP levels, emphasizing the importance of these markers in children. The most common pathogens were E. coli and B. fragilis, with specific organisms varying by the site of infection. For example, E. coli was frequently isolated from renal sources, while Streptococcus viridans was more common in hepatic abscesses. Tubo-ovarian abscesses in non-sexually active adolescents often involved anaerobic gut flora as the primary cause. Risk factors and immune responses may differ in specific populations. A study examining inflammatory cytokines in patients with type 2 diabetes showed significant differences in interleukin (IL)-8 and IL-10 levels between those with and without intra-abdominal abscesses, suggesting that markers of infection can vary based on underlying health conditions.

Pathophysiology of Intra-abdominal Abscess

Intra-abdominal abscesses develop from a complex interplay of infection, inflammation, and the body’s attempt to contain the source of injury. They can be localized or widespread within the peritoneal cavity and frequently arise following gastrointestinal perforation, trauma, or surgical procedures. Postoperative fluid collections, for instance, typically evolve into encapsulated abscesses over 5 to 7 days. These purulent collections are contained by adhesions involving the omentum or nearby organs, acting as a containment strategy by the host’s immune system.

Abscess formation begins with the invasion of pathogens, often a mix of aerobic and anaerobic bacteria like E. coli and B. fragilis. These pathogens trigger an inflammatory response involving neutrophils, macrophages, and cytokines such as tumor necrosis factor-alpha (TNF-α), IL-1, and IL-6. These immune responses create a hypertonic microenvironment that expands the abscess cavity. For example, the polysaccharide capsule of B. fragilis enhances its virulence by allowing it to survive and multiply within the anaerobic and acidic conditions of the abscess.

Anaerobic metabolism within the abscess cavity leads to tissue hypoxia, reduced oxygen diffusion across capillary membranes, and increased lactate levels, which are linked to higher mortality. These conditions impede oxygen penetration and create an environment resistant to antibiotic treatment and immune clearance. This environment not only sustains the abscess but also elevates the risk of systemic complications such as sepsis if left untreated. The encapsulating pseudo-capsule, mainly composed of fibrin and collagen, restricts pathogen spread but also hinders antibiotic penetration and neutrophil function, making the abscess a protected environment for microbial survival. In Crohn’s disease, the chronic inflammation leads to strictures, fibrostenosis, and potential perforation, which can cause abscess formation and fistulas between structures like the bowel, bladder, and abdominal wall. Similarly, aseptic abscess syndrome, often associated with inflammatory bowel disease, is characterized by sterile neutrophilic infiltrates and granulomatous reactions around the collections, distinguishing it from infectious abscesses.

Without proper treatment, abscesses can enlarge due to ongoing inflammation, anaerobic bacterial activity, and the hypertonic environment. This can lead to further complications, including peritonitis and systemic sepsis, significantly increasing illness and death rates. Aseptic abscess syndrome, though non-infectious, shares a similar immune-mediated inflammatory basis and is often characterized by granulomatous reactions, distinct from other neutrophilic conditions like pyoderma gangrenosum.

History and Physical Examination in Differential Diagnosis Abscess

History

A detailed patient history is crucial in the differential diagnosis abscess. Patients commonly present with nonspecific symptoms such as fever, general discomfort (malaise), fatigue, and localized or widespread abdominal pain, typically described as dull, persistent, and worsened by movement or deep breathing. Nausea, vomiting, and loss of appetite (anorexia) are also frequent, particularly if the abscess is causing gastrointestinal obstruction or inflammation. Chronic symptoms, such as unexplained weight loss or night sweats, may indicate a more prolonged or underlying process. Understanding the timeline of symptom onset and progression is vital, as acute abscesses, like those following appendicitis or diverticular perforation, often present rapidly with severe pain and systemic signs of infection. In contrast, more chronic presentations may suggest underlying conditions such as Crohn’s disease or postoperative complications.

A thorough surgical history is essential, given that a significant portion of intra-abdominal abscesses are hospital-acquired, frequently resulting from anastomotic leaks, retained foreign bodies, or surgical site contamination. A recent history of abdominal or pelvic surgery, trauma, or invasive procedures like peritoneal dialysis is highly relevant. Pre-existing conditions such as inflammatory bowel disease, diverticulitis, or malignancy can predispose individuals to abscess formation. Infectious disease history is also critical. For example, endocarditis may suggest splenic or hepatic abscesses, while a history of tuberculosis or amebiasis in endemic regions may point to less common infectious causes. Social and environmental factors, such as intravenous drug use, travel to regions where specific pathogens like Entamoeba histolytica are common, or dietary habits, can provide further context.

Risk factors such as diabetes mellitus, malignancy, immunosuppressive therapy, or recent antibiotic use can increase susceptibility to infection and complicate management. Poorly controlled diabetes is associated with severe or polymicrobial abscesses. A review of systems can reveal related symptoms, such as diarrhea, constipation, urinary frequency, or painful urination (dysuria), which may suggest abscesses adjacent to the gastrointestinal or urinary tract. For instance, pelvic pain might indicate a tubo-ovarian abscess, while right upper quadrant pain with referred shoulder pain could suggest a hepatic abscess. Attention should also be paid to systemic signs of sepsis, including high fever, chills, low blood pressure (hypotension), rapid heart rate (tachycardia), and changes in mental status, as these indicate advanced infection requiring immediate intervention. A comprehensive history allows clinicians to narrow the differential diagnosis abscess, identify potential sources of infection, and guide diagnostic and therapeutic strategies effectively.

Physical Examination

The physical examination of a patient with a suspected abdominal abscess often reveals signs of localized or systemic infection, ranging from subtle findings in mild cases to clear indicators of sepsis in severe presentations. The patient’s general appearance may suggest distress, fatigue, or malaise, possibly with paleness, sweating, and rapid breathing if sepsis or systemic inflammatory response syndrome is present. Fever is common, though it may be absent in individuals with weakened immune systems or chronic abscesses. Rapid heart rate, low blood pressure, and altered mental status suggest hemodynamic instability, a sign of advanced infection or septic shock. Many patients may be dehydrated and producing less urine (oliguria).

Abdominal examination typically reveals tenderness, often localized to the area of the abscess, although generalized tenderness may occur in cases of associated peritonitis. Muscle guarding, rebound tenderness, or rigidity may indicate irritation of the peritoneum. Palpation might reveal a palpable mass or fullness, especially with superficial or large abscesses. For example, a pelvic abscess might be felt as tenderness in the lower abdomen, while a subphrenic abscess could cause referred shoulder pain or tenderness in the right upper quadrant. Percussion may produce a tympanic sound if an abscess has caused bowel obstruction or a dull sound over a large fluid collection. Auscultation may reveal reduced bowel sounds, suggesting ileus or inflammation affecting gastrointestinal motility.

Additional signs may suggest specific abscess locations or complications. For instance, jaundice or liver enlargement (hepatomegaly) may accompany a hepatic abscess, while flank tenderness or pain in the costovertebral angle might suggest a retroperitoneal or renal source. Pelvic examination in female patients may reveal tenderness in the adnexa, a palpable mass, or cervical motion tenderness, raising suspicion for a tubo-ovarian abscess or pelvic inflammatory disease. A rectal examination might identify tenderness, fluctuance, or masses indicating a perirectal or deep pelvic abscess.

The presentation and physical findings can also vary based on the cause and location of the abscess. For example, Crohn’s disease is commonly associated with abdominal pain and weight loss, which may precede abscess formation. In postoperative patients, the diagnosis of an abdominal abscess may be delayed due to pain relief medication, but fever, pain, nausea, and anorexia may raise suspicion. A subphrenic abscess may present with shoulder pain, hiccups, or lung collapse (atelectasis). A tubo-ovarian abscess may present with abdominal pain, nausea, vomiting, diarrhea, and fevers. A foul odor and crackling sensation (crepitance) upon palpation often characterize anaerobic infections. If the abscess extends into extra-abdominal areas, such as the chest, lower back, buttocks, sacrum, coccyx, or leg, it will cause pain in these regions. If the abscess is retroperitoneal or deep in the pelvis, signs and symptoms may be vague and relatively minor, including fever, mild liver dysfunction, or prolonged ileus.

In patients showing signs of systemic infection or instability, physical examination should extend beyond the abdomen to assess for complications like respiratory distress (suggestive of subphrenic abscess) or joint or extremity findings that could indicate hematogenous spread or septic arthritis. Findings like redness, warmth, or firmness over the abdomen might indicate a superficial abscess or cellulitis. In all cases, physical exam findings should be correlated with the clinical history and imaging studies to confirm the differential diagnosis abscess and guide management.

Evaluation for Differential Diagnosis Abscess

The evaluation process for a patient suspected of having an intra-abdominal abscess, crucial for accurate differential diagnosis abscess, begins with a thorough history and physical examination, followed by specific diagnostic tests to confirm the diagnosis, locate the abscess, and assess for complications. Key components include blood tests, imaging studies, and microbiological cultures. Blood tests often reveal elevated white blood cell count (leukocytosis), abnormal liver function tests, anemia, and low platelet count (thrombocytopenia). Blood cultures may be negative, but when positive, they frequently show anaerobic organisms, with B. fragilis being a common isolate.

Other markers, such as CRP and procalcitonin, can help assess the degree of inflammation or infection, guiding further management. Serum markers like cancer antigen 125 may also be useful in predicting disease severity in conditions such as complicated diverticulitis, where higher levels correlate with larger abscesses and a greater need for invasive interventions. Retrospective studies have shown that laboratory data from postoperative day 3 can be predictive of infection.

Imaging is essential in confirming the differential diagnosis abscess and determining the abscess’s location and relationship to surrounding structures. Ultrasound is often the initial imaging choice, especially in children, due to its accessibility and lack of radiation. For adults, contrast-enhanced computed tomography (CT) is the gold standard for diagnosing intra-abdominal abscesses. CT imaging provides detailed information about the abscess’s size, location, and relationship to adjacent organs, and it can also help identify the source of contamination, such as perforated diverticula, appendicitis, or bowel perforation. CT is favored over ultrasound because it is less affected by dressings or drains and offers better visualization, particularly with intravenous contrast. In pregnant patients, ultrasound or magnetic resonance imaging (MRI) is preferred to avoid radiation exposure. MRI is less commonly used but can provide detailed soft tissue imaging, especially in complex cases.

CT-guided aspiration is another key diagnostic tool, allowing for sampling the abscess fluid for microbiological cultures and, if necessary, placement of a drain to aid in resolving the infection. Repeat imaging and cultures may be necessary if there is no clinical improvement with antibiotics after several days, particularly in cases caused by anaerobic bacteria. Indicators of anaerobic infection include a foul odor, gas formation within the abscess, bowel and vascular structures, and the portal venous system.

In addition to standard imaging, experimental technologies are being explored to improve diagnosis and treatment outcomes. Studies are investigating methods for measuring the optical properties of an abscess cavity and the uptake of methylene blue for photodynamic therapy, which may help treat recurrent or antibiotic-resistant abscesses. Current guidelines recommend CT as the initial imaging modality for adults and adolescents with suspected intra-abdominal abscesses, with intravenous contrast to enhance visualization of the abscess wall. In cases where imaging is inconclusive or if there is no clinical response to treatment, repeat imaging and cultures may be warranted to assess for complications or guide further therapeutic interventions, refining the differential diagnosis abscess.

Treatment and Management of Intra-abdominal Abscess

Effective treatment of intra-abdominal abscesses, guided by accurate differential diagnosis abscess, prioritizes source control, combining antibiotics, drainage, debridement, and removal of any foreign materials. Broad-spectrum antibiotics are started early and then refined based on culture results. The decision between drainage and antibiotics alone is debated, with abscess size and inflammatory markers like CRP influencing management strategies. Supportive measures, such as nasogastric tubes and parenteral nutrition, may aid recovery. Percutaneous image-guided drainage has been shown to reduce hospital stay duration. Improvement is typically seen within 48 hours post-drainage. CT-guided drainage boasts a success rate exceeding 90% for localized abscesses and is considered standard care. Drain management protocols are tailored based on the abscess size and cause. Crohn’s disease, for example, is associated with fistula formation, and patients with related abscesses may require additional imaging. Surgical drainage is necessary for abscesses that fail percutaneous drainage or are inaccessible to it.

The Infectious Disease Society of America provides updated guidelines on intra-abdominal infections, including guidance on intra-abdominal abscesses, emphasizing risk stratification using scoring systems like the Acute Physiology and Chronic Health Evaluation II (APACHE II) score or the World Society of Emergency Surgery Sepsis Severity Score. These guidelines recommend CT as the initial imaging modality for nonpregnant adults and adolescents with suspected intra-abdominal abscesses, including intravenous contrast, and ultrasound for children. MRI is suggested as an alternative, though sedation may be needed for either modality in children. For pregnant individuals, MRI or ultrasound are the preferred imaging methods.

The Surgical Infection Society Guidelines for Management of Intra-abdominal Infection offer recommendations for antimicrobial therapy based on risk stratification and clinical trial data. General recommendations include initiating antimicrobial therapy within one hour for high-risk patients with sepsis, noting that delays beyond six hours increase mortality. The World Journal of Emergency Surgery guidelines also emphasize early source control, including image-guided drainage, and early empiric antibiotic treatment to improve outcomes in septic patients. These guidelines advocate for an individualized approach to antibiotic therapy to enhance efficacy and minimize resistance. Recent studies indicate that gram-negative bacteria in intra-abdominal abscesses are most responsive to meropenem, followed by piperacillin-tazobactam, and gram-positive bacteria show high responsiveness to amoxicillin-clavulanic acid, piperacillin-tazobactam, and meropenem.

The approach to abscess treatment varies by anatomical location. Subdiaphragmatic abscesses can be drained percutaneously, while pelvic abscesses are accessed transrectally or transvaginally. Endoscopic ultrasound-guided drainage offers a minimally invasive treatment option. Transesophageal and transgastric approaches have been used for subphrenic abscesses. Splenic abscesses, traditionally treated with splenectomy, now see percutaneous drainage associated with lower mortality and complication rates. Factors such as abscess size, patient age, inflammatory markers, white blood cell count, and erythrocyte sedimentation rate can predict the need for surgical intervention due to pharmacologic treatment failure.

Studies have shown the benefits of nonoperative management with drain placement for appendicitis complicated by abscesses, including fewer complications, shorter hospitalizations, fewer wound infections, and reduced ileus incidence. However, a multicenter study on prophylactic drains in perforated appendicitis showed that drain placement did not reduce abscess incidence and was linked to longer hospital stays. Abscess size, specifically less than 4 cm, is associated with successful percutaneous drain management of appendicitis-related abscesses in children. Postoperative studies in pediatric perforated appendicitis with abscess have shown that the time between diagnosis and percutaneous drainage does not affect outcomes. In contrast, abscess size does impact the duration of intravenous antibiotic treatment and hospital stay in post-appendectomy abscesses in children.

For diverticular abscesses, a size of 3 to 6 cm is generally considered suitable for percutaneous drainage. Studies suggest surgical intervention for collections smaller than 4 cm may reduce recurrent diverticular abscess risk. A multicenter study developed a model predicting the need for emergency surgery in diverticular abscess cases, identifying immunosuppression, CRP levels, free air, and larger abscess size as key factors.

In Crohn’s disease, treatment of spontaneous abscesses, whether immediate resection or nonoperative management, depends on the clinical presentation. Studies suggest good surgical outcomes following initial nonoperative management of Crohn’s abscesses. Factors like abscess diameter, sinus width, and abscess location are associated with the need for invasive treatment. Additional studies link bowel wall thickness, dilation, length of the involved segment, and abscess size greater than 6 cm to the need for subsequent surgery. Comparisons of antibiotics, percutaneous drainage, and surgical drainage in Crohn’s disease patients indicate abscess size as a factor in treatment efficacy. Percutaneous drainage is often considered safer and generally as effective as surgery. Patients recovering from nonoperative treatment of Crohn’s abscesses may benefit from anti-tumor necrosis factor biologics, especially those without prior resections.

Studies have examined the optimal timing for surgical intervention in Crohn’s disease patients undergoing percutaneous drainage of intra-abdominal abscesses. Resection within 6 weeks of drainage has been associated with higher morbidity and anastomotic leak rates. Postoperative complications following resection for Crohn’s disease after nonoperative abscess drainage are linked to factors like age, residual abscess, smoking status, low serum albumin, and time interval to surgery.

For aseptic abscess syndrome in inflammatory bowel disease, antibiotics are ineffective, and treatment typically involves intravenous corticosteroids followed by maintenance therapy with biologics or disease-modifying antirheumatic drugs and steroids. Relapses on steroids alone are possible and must be differentiated from opportunistic infections prompted by immunosuppressive therapy. Innovation continues to expand treatment options, including photodynamic therapy for persistent or recurrent abscesses, using reactive oxygen species and photosensitizers like methylene blue. Initial studies are measuring abscess cavity optical properties and methylene blue uptake to optimize this therapy.

Differential Diagnosis of Intra-abdominal Abscess

The differential diagnosis abscess in the abdomen is extensive due to the nonspecific nature of presenting symptoms, which can overlap with numerous conditions. Common symptoms like fever, abdominal pain, nausea, and vomiting are seen in a wide range of abdominal pathologies. Radiographic imaging plays a key role in distinguishing between intra-abdominal space-occupying masses, and a detailed history, physical examination, and early imaging findings are crucial to refine the diagnosis. Conditions that should be considered in the differential diagnosis abscess include:

• Malignancy: Tumors or cancers, particularly of the gastrointestinal tract (e.g., colorectal cancer), pancreas, liver, or ovaries, can present as mass-like lesions that may mimic abscesses. Necrosis within malignant tumors can also lead to fluid collections resembling abscesses.
• Benign Mass: Noncancerous masses, such as fibroids or lipomas, can present with clinical features similar to abscesses, especially if large and causing localized abdominal pain or discomfort.
• Fever of Unknown Origin (FUO): While intra-abdominal abscesses can cause fever, FUO has a broad differential, including various infections, malignancies, and inflammatory conditions that must be considered.
• Hernia: Abdominal hernias, especially incarcerated or strangulated hernias, can present with localized pain, fever, and abdominal distension, mimicking an abscess.
• Hematoma: Abdominal hematomas resulting from trauma or surgery can present with a mass, tenderness, and pain, making differentiation from an abscess challenging, particularly postoperatively.
• Organ Infarction: Infarction of intra-abdominal organs, such as the spleen or liver, can cause localized pain and form fluid collections resembling an abscess.
• Ascites: Fluid accumulation in the peritoneal cavity due to liver disease, malignancy, or heart failure can cause abdominal distension and tenderness. While ascites can sometimes be complicated by infection, it should be distinguished from an abscess.
• Peritonitis: Inflammation or infection of the peritoneum can cause symptoms and signs that overlap with abscesses, including fever, tenderness, and abdominal distension.
• Other Considerations:
  • Pancreatic pseudocysts
  • Inflammatory bowel diseases (flare-ups can mimic abscess formation)

A systematic approach using clinical evaluation and imaging is essential to accurately establish the differential diagnosis abscess and guide appropriate management.

Pertinent Studies and Ongoing Trials

Recent research continues to refine our understanding of intra-abdominal abscesses. Yuan et al. found that a lower prognostic nutritional index is associated with an increased risk of intra-abdominal abscess following laparoscopic appendectomy for perforated appendicitis in older adults. Smith et al.’s study on liver trauma patients identified injury mechanism, intraoperative massive transfusion, bile leak, hospital length of stay, and additional injuries as independent risk factors for abscess formation.

Intra-abdominal abscess following pancreatic surgery has been identified as an independent risk factor for delayed postpancreatectomy hemorrhage, particularly in patients not undergoing abscess drainage. Zheng et al.’s study on pediatric perforated appendicitis found significant overlap in laboratory values between patients with and without abscess formation, highlighting the limitations of labs in predicting abscess development in this population.

Studies evaluating intraoperative peritoneal lavage have shown no reduction in postoperative abscess rates. Jen et al.’s research indicated that post-discharge antibiotics do not prevent intra-abdominal abscesses in children treated for perforated appendicitis. Conversely, Muñoz-Serrano et al. found that administering antibiotics within the first 8 hours of diagnosis in pediatric acute appendicitis reduced intra-abdominal abscess incidence significantly. Podda et al.’s multicenter study identified risk factors for nonoperative treatment failure in diverticular abscesses, including Hinchey abscess classification, air within the abscess cavity, and smoking status.

Frediani et al.’s Italian study demonstrated the efficacy of intraperitoneal cefazolin irrigation in preventing postoperative abscesses after laparoscopic appendectomy in children. Researchers have also developed classification systems based on peritoneal contamination in perforated appendicitis to predict postoperative complications, including intra-abdominal abscess. These ongoing studies and classifications are crucial for enhancing prevention and management strategies, and refining the differential diagnosis abscess.

Prognosis of Intra-abdominal Abscess

The prognosis for intra-abdominal abscesses is influenced by several critical factors, including timely diagnosis and intervention, patient comorbidities, abscess characteristics, and the effectiveness of management. Complicated intra-abdominal infections can have mortality rates as high as 40%, especially when associated with sepsis, delayed diagnosis, or inadequate source control. Factors like advanced age, malnutrition, diabetes, chronic anemia, and limited access to specialized surgical centers can worsen clinical outcomes, increasing risks of perforation, peritonitis, and abscess formation.

Prognostic Factors and Outcomes

Prompt and effective source control, such as image-guided drainage, is essential for reducing morbidity and improving survival rates. Delays in treatment, particularly beyond 6 hours in septic patients, significantly increase mortality. Sepsis, recurrent surgeries, and loculated abscesses further elevate risks. Prognostic laboratory markers, such as elevated CRP (>12.06 mg/dL) and blood urea nitrogen (>21 mg/dL), are associated with a higher need for inotropic support and poorer outcomes.

Studies emphasize the role of abscess size in determining the success of conservative management. Larger abscesses, especially in diverticular disease, are more likely to fail nonsurgical interventions. Postoperative intra-abdominal infections, especially in cancer patients, may negatively impact short-term outcomes like recurrence-free intervals but may not significantly affect long-term survival in colorectal cancer patients.

Mortality and Complications

Untreated or misdiagnosed intra-abdominal abscesses carry a very high mortality rate. Key factors contributing to mortality and morbidity include:

• Sepsis and organ dysfunction
• Delay in initiating appropriate treatment
• Advanced age and frailty
• Presence of multiple comorbidities, such as diabetes or immunosuppression
• Loculated or complex abscess collections requiring advanced drainage techniques

Advances in Management and Prognosis

Image-guided drainage, often the first-line intervention for accessible abscesses, significantly reduces morbidity by avoiding invasive surgery. Surgical options, including laparotomy or laparoscopy, provide effective source control for abscesses resistant to percutaneous drainage. Abscess size and presence of complications often guide decisions regarding elective or urgent surgery for diverticular abscesses. Continued advancements in management are improving the prognosis and refining strategies for differential diagnosis abscess.

Complications of Intra-abdominal Abscess

Intra-abdominal abscesses, frequently arising from surgery or untreated intra-abdominal infections, can lead to significant complications if not properly managed, further complicating the differential diagnosis abscess if secondary issues arise. Local complications include peritonitis due to abscess rupture, fistula formation into adjacent organs, bowel obstruction from inflammatory edema or adhesions, and erosion into vascular structures causing severe hemorrhage. Chronic inflammation may also result in adhesions, fibrosis, and recurrent abscesses, complicating future surgeries. Systemic complications include sepsis, septic shock, multiorgan dysfunction syndrome, bacteremia, infective endocarditis, thromboembolic events, and systemic inflammatory response syndrome. Long-term sequelae, such as chronic pain, malnutrition, and recurrent abscesses, are common, especially in patients with underlying comorbidities.

Drainage of abscesses, whether percutaneous or surgical, is essential but carries inherent risks. Incomplete drainage may leave a residual abscess cavity prone to biofilm formation and antibiotic resistance. Drain-related complications include perforation of nearby organs or blood vessels, retrograde infection from prolonged drain indwelling time, and drain clogging from sampling for culture. Persistent infection or inadequate drainage can lead to septic sequelae, including deep vein thromboses and fistula formation.

Timely and effective source control, early drainage, and appropriate antibiotic therapy are crucial to minimize morbidity and mortality. Prognosis is significantly influenced by patient age, comorbidities (e.g., diabetes, chronic anemia), sepsis presence, and the speed of intervention. Preventing complications requires a multidisciplinary approach, including precise diagnostic imaging, careful selection of drainage techniques, and vigilant postprocedure monitoring for recurrence or systemic deterioration. These factors are critical in managing and understanding the complications within the context of differential diagnosis abscess.

Postoperative and Rehabilitation Care

Postoperative and rehabilitative care is vital for patients recovering from intra-abdominal abscesses, aiming to promote healing, prevent recurrence, and manage complications, all of which are important considerations in the ongoing differential diagnosis abscess process during recovery. Regular clinical assessments and imaging, such as ultrasound or CT scans, are essential to confirm abscess resolution and detect potential complications like recurrent abscesses, fistulas, or persistent infections. Continued antibiotic therapy, tailored to culture results, is crucial for eradicating residual infection, with vigilance for signs of sepsis or secondary infections. Proper management of surgical or percutaneous drains, including timely removal, minimizes the risk of retrograde infections or clogging. Nutritional support is critical, focusing on a high-protein, nutrient-rich diet or supplemental enteral or parenteral nutrition for patients with significant weight loss or poor oral intake.

Rehabilitation programs should gradually reintroduce physical activity to prevent complications like deep vein thrombosis and promote overall recovery. Optimizing chronic conditions such as diabetes, anemia, or immunosuppression is crucial to enhance recovery and reduce recurrence risk. Additionally, addressing mental health needs and providing psychological support can help patients manage stress or anxiety related to their illness or prolonged recovery. Comprehensive, interdisciplinary care is essential to ensure successful recovery and minimize long-term sequelae, while remaining alert to any signs necessitating reconsideration of the differential diagnosis abscess.

Consultations for Intra-abdominal Abscess

Managing intra-abdominal abscesses effectively necessitates a collaborative, interprofessional approach involving multiple specialists, each contributing to the refinement of the differential diagnosis abscess and treatment plan. Radiologists and interventional radiologists are critical for diagnosing and managing abscesses through imaging and percutaneous drainage. General surgeons oversee surgical interventions when drainage is insufficient or the abscess is inaccessible. Gastroenterologists may assist in managing underlying conditions like Crohn’s disease, while oncologists and gynecologists may be involved depending on the etiology, such as malignancy or gynecologic sources. Pharmacists ensure appropriate antibiotic stewardship, and infectious disease experts guide antimicrobial therapy based on culture data. This teamwork is essential for optimizing outcomes and patient safety, ensuring all aspects of the differential diagnosis abscess are thoroughly addressed.

Deterrence and Patient Education for Intra-abdominal Abscess

Deterrence and patient education are vital in managing and preventing intra-abdominal abscesses, and educating patients about risk factors can aid in early differential diagnosis abscess when symptoms arise. Patients should be educated on the importance of seeking timely medical evaluation for abdominal pain, fever, or signs of infection, as delays in diagnosis and treatment can lead to severe complications. Educating patients about the risks associated with surgical procedures, particularly those with predisposing factors like diabetes, immunosuppression, or malnutrition, can help them understand their role in preventing infections. Patients should be advised on the importance of adhering to prescribed antibiotics and completing the full course of therapy to reduce recurrence or resistance risks.

For those undergoing surgical or percutaneous interventions, proper wound care and awareness of wound infection signs are crucial. Maintaining optimal nutrition and controlling underlying chronic conditions, such as diabetes or anemia, are essential preventive strategies. In cases where abscess formation is linked to specific diseases, like diverticulitis or inflammatory bowel disease, patients should be educated about managing these conditions and recognizing early signs of complications. Encouraging regular follow-ups and imaging studies when indicated ensures ongoing monitoring and early intervention if needed. Empowering patients with knowledge and resources fosters better outcomes and reduces the likelihood of recurrence, and promotes informed participation in their own differential diagnosis abscess and management.

Pearls and Other Issues in Intra-abdominal Abscess Management

Antibiotic stewardship is crucial in managing intra-abdominal abscesses, reducing healthcare-associated infections and related costs. Recommendations include using hospital antibiograms and screening for carbapenemase-producing Enterobacterales. Monitoring intraperitoneal flora throughout hospitalization is important to avoid increasingly resistant strains during subsequent interventions. Consulting with a pharmacist and infectious disease specialist is vital for guiding decision-making, especially in complex cases that affect the differential diagnosis abscess. Studies in pediatric post-appendectomy abscesses show high rates of antibiotic resistance, emphasizing the need for culture-directed antibiotic therapy.

The immediate physiological impact of intra-abdominal abscesses is significant. In cases of clinical deterioration post-trauma laparotomy or prolonged hospitalization, while pulmonary embolism may be suspected, abscesses are a more frequent finding. Postoperative infections in malignancy patients contribute to recurrence and reduced survival rates.

Visceral fat may correlate with increased risk for postoperative complications, including intra-abdominal abscesses. Studies suggest that a higher abdominal depth to body mass ratio is an independent risk factor for complications after laparoscopic pancreaticoduodenectomy. Improving nutrition in patients with low skeletal muscle mass may reduce postoperative infections. Preoperative enteral nutrition may reduce postoperative complications, including abscesses, in Crohn’s disease patients. Enhanced recovery after surgery programs have been shown to reduce intra-abdominal abscess rates after gastrectomy for gastric cancer. Sarcopenia has been identified as an independent risk factor for intra-abdominal abscess and bile leak after hepatectomy for hepatocellular carcinoma. Imaging in aseptic abscess syndrome may reveal multiple abscesses in various organs, and colonoscopy is recommended for patients without a prior inflammatory bowel disease diagnosis. These diverse factors and considerations are essential for comprehensive management and refinement of the differential diagnosis abscess approach.

Enhancing Healthcare Team Outcomes in Intra-abdominal Abscess Management

Managing intra-abdominal abscesses demands a coordinated interprofessional approach involving clinicians, nurses, pharmacists, and other healthcare professionals. A systematic clinical interprofessional team approach is essential to reduce morbidity and mortality associated with abdominal abscesses, ensuring all aspects of differential diagnosis abscess and treatment are addressed collaboratively. These abscesses can be diagnostically and therapeutically challenging, making timely and effective communication within the team crucial. Nurses and advanced clinicians play a key role in continuous monitoring for signs of deterioration, including drain output and patient clinical status. The surgical team oversees interventions, ensuring timely source control and managing complications.

Pharmacists are integral in guiding antibiotic therapy, ensuring regimens are tailored to culture results and hospital antibiograms to combat resistant organisms effectively. Nutritionists significantly contribute by calculating caloric needs and addressing dietary deficiencies, particularly for patients requiring total parenteral nutrition. The surgical team provides critical oversight, monitoring drain outputs and clinical status to prevent delays in treatment, which could lead to adverse events and increased healthcare costs. The key to improving outcomes for intra-abdominal abscesses is a coordinated interprofessional approach, with prompt diagnosis, vigilant monitoring, and early, targeted treatment, all underpinned by a shared understanding and refinement of the differential diagnosis abscess.

Review Questions

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References

(Note: References from the original article are retained as per instructions)

1.Ozgun YM, Oter V, Piskin E, Colakoglu MK, Aydin O, Aksoy E, Dalgic T, Bostanci EB. Treatment Modalities and the Role of Endoscopy for Delayed Gastric Emptying After Whipple Operation: Analysis of 53 Patients. Am Surg. 2022 Feb;88(2):273-279. [PubMed: 33517709]

2.Alharbi KS, Singh Y, Hassan Almalki W, Rawat S, Afzal O, Alfawaz Altamimi AS, Kazmi I, Al-Abbasi FA, Alzarea SI, Singh SK, Bhatt S, Chellappan DK, Dua K, Gupta G. Gut Microbiota Disruption in COVID-19 or Post-COVID Illness Association with severity biomarkers: A Possible Role of Pre / Pro-biotics in manipulating microflora. Chem Biol Interact. 2022 May 01;358:109898. [PMC free article: PMC8934739] [PubMed: 35331679]

3.Thompson DT, Hrabe JE. Intra-abdominal and Anorectal Abscesses. Gastroenterol Clin North Am. 2021 Jun;50(2):475-488. [PubMed: 34024453]

4.Sarychev LP, Sarychev YV, Pustovoyt HL, Sukhomlin SA, Suprunenko SM. Management of the patients with blunt renal trauma: 20 years of clinical experience. Wiad Lek. 2018;71(3 pt 2):719-722. [PubMed: 29783255]

5.Son DJ, Hong JY, Kim KH, Jeong YH, Myung DS, Cho SB, Lee WS, Kang YJ, Kim JW, Joo YE. Liver abscess caused by Clostridium haemolyticum infection after transarterial chemoembolization for hepatocellular carcinoma: A case report. Medicine (Baltimore). 2018 May;97(19):e0688. [PMC free article: PMC5959397] [PubMed: 29742715]

6.Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, Melchio R, Fenoglio LM. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore). 2018 May;97(19):e0628. [PMC free article: PMC5959441] [PubMed: 29742700]

7.Méchaï F, Kolakowska A, Carbonnelle E, Bouchaud O, Tresallet C, Jaureguy F. Intra-abdominal abscesses: Microbiological epidemiology and empirical antibiotherapy. Infect Dis Now. 2023 Feb;53(1):104604. [PubMed: 36067948]

8.Bonomo RA, Tamma PD, Abrahamian FM, Bessesen M, Chow AW, Dellinger EP, Edwards MS, Goldstein E, Hayden MK, Humphries R, Kaye KS, Potoski BA, Rodríguez-Baño J, Sawyer R, Skalweit M, Snydman DR, Donnelly K, Loveless J. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Intra-abdominal Abscess in Adults, Children, and Pregnant People. Clin Infect Dis. 2024 Oct 04;79(Supplement_3):S113-S117. [PubMed: 38963815]

9.Çay Ü, Alabaz D, Ö Gündeşlioglu Ö, Tutuş K, K Çil M, Pehlivan UA. Multi-organ/disseminated echinococcosis in children: Case series and review of the literature. J Paediatr Child Health. 2022 Jul;58(7):1193-1200. [PubMed: 35262239]

10.Gray M, Marland JRK, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. J Pers Med. 2021 May 25;11(6) [PMC free article: PMC8229046] [PubMed: 34070593]

11.Iritani S, Kawamura Y, Yamashige D, Muraishi N, Kajiwara A, Fujiyama S, Sezaki H, Hosaka T, Akuta N, Kobayashi M, Kobayashi M, Saitoh S, Suzuki F, Arase Y, Ikeda K, Suzuki Y, Kumada H. An encapsulated bulky abdominal abscess due to amoeba. Clin J Gastroenterol. 2021 Apr;14(2):555-559. [PubMed: 33428067]

12.Nishikawa M, Honda M, Kimura R, Kobayashi A, Yamaguchi Y, Hori S, Kobayashi H, Waragai M, Kawamura H, Nakayama Y, Todate Y, Takano Y, Yamaguchi H, Hamada K, Iketani S, Seto I, Izumi Y, Seto K. The bacterial association with oral cavity and intra-abdominal abscess after gastrectomy. PLoS One. 2020;15(11):e0242091. [PMC free article: PMC7652288] [PubMed: 33166362]

13.Lim RS, See YP. Pyogenic liver abscesses in peritoneal dialysis patients: A single-centre retrospective case series. Perit Dial Int. 2024 Nov;44(6):459-462. [PubMed: 38644580]

14.Alemu BN, Tiruneh AG. Gossypiboma: A Case Series and Literature Review. Ethiop J Health Sci. 2020 Jan;30(1):147-149. [PMC free article: PMC7036463] [PubMed: 32116444]

15.Rasslan R, Alves V, Damous SHB, de Santis A, Tarasoutchi F, Menegozzo CAM, Akamine M, Rasslan S, Utiyama EM. Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil. J Invest Surg. 2022 Nov-Dec;35(11-12):1836-1840. [PubMed: 36202396]

16.Liu A, Liu H, Ding X, Wu J, Tian Z, Mao T. Familial adenomatous polyposis associated with desmoid tumors presenting with abdominal abscess: A case report and literature review. Medicine (Baltimore). 2021 Nov 19;100(46):e27897. [PMC free article: PMC8601329] [PubMed: 34797340]

17.Casas Deza D, Polo Cuadro C, de Francisco R, Vela González M, Bermejo F, Blanco I, de la Serna Á, Bujanda L, Bernal L, Rueda García JL, Gargallo-Puyuelo CJ, Fuentes-Valenzuela E, Castro B, Guardiola J, Ladrón G, Suria C, Sáez Fuster J, Gisbert JP, Sicilia B, Gomez R, Muñoz Vilafranca C, Barreiro-De Acosta M, Peña E, Castillo Pradillo M, Cerrillo E, Calvet X, Manceñido N, Monfort I Miquel D, Marín S, Roig C, Marce A, Ramírez de Piscina P, Betoré E, Martin-Cardona A, Teller M, Alonso Abreu I, Maroto N, Frago S, Gardeazabal D, Pérez-Martínez I, Febles González ÁD, Barrero S, Taxonera C, García de la Filia I, Ezkurra-Altuna A, Madero L, Martín-Arranz MD, Gomollón F, Domènech E, García-López S. Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn’s Disease: A National, Multicentre Study Based on ENEIDA Registry. J Crohns Colitis. 2024 Apr 23;18(4):578-588. [PubMed: 37930823]

18.Waked B, Holvoet T, Geldof J, Baert F, Pattyn P, Lobatón T, Hindryckx P. Conservative management of spontaneous intra-abdominal abscess in Crohn’s disease: Outcome and prognostic factors. J Dig Dis. 2021 May;22(5):263-270. [PubMed: 33742782]

19.Parillo M, Bernetti C, Altomare C, Beomonte Zobel B, Quattrocchi CC. Extrahepatic abscess and dropped gallstones: a case report and a narrative review of an unusual delayed complication of laparoscopic cholecystectomy. Acta Chir Belg. 2024 Feb;124(1):57-61. [PubMed: 36576306]

20.Slezák M, Smolár M, Mikolajčík A, Janík J, Miklušica J. Appendicolith as a cause of late complications after appendectomy – a case report and literature review. Rozhl Chir. 2022 Spring;101(5):251-254. [PubMed: 35667876]

21.Lee K, Lee JW, Jung HR, Park M, Cho KB, Lee JY. A case of colonic MALT lymphoma with intra-abdominal abscess and lung metastasis: A case report. Medicine (Baltimore). 2023 Oct 27;102(43):e35778. [PMC free article: PMC10615456] [PubMed: 37904387]

22.Nihei M, Kamada T, Aida T, Yamagishi D, Takahashi J, Nakashima K, Ito E, Suzuki N, Hata T, Yoshida M, Ohdaira H, Suzuki Y. Rare symptom of left inguinal abscess secondary to a retroperitoneal perforation of diverticulitis of the sigmoid colon: A case report. Medicine (Baltimore). 2024 Sep 27;103(39):e39770. [PMC free article: PMC11441901] [PubMed: 39331910]

23.Coakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clin Colon Rectal Surg. 2021 Mar;34(2):96-103. [PMC free article: PMC7904332] [PubMed: 33642949]

24.Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, Balogh ZJ, Di Saverio S, Weber D, Ten Broek RP, Abu-Zidan FM, Campanelli G, Beka SG, Chiarugi M, Shelat VG, Tan E, Moore E, Bonavina L, Latifi R, Hecker A, Khan J, Coimbra R, Tebala GD, Søreide K, Wani I, Inaba K, Kirkpatrick AW, Koike K, Sganga G, Biffl WL, Chiara O, Scalea TM, Fraga GP, Peitzman AB, Catena F. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg. 2022 Mar 04;17(1):13. [PMC free article: PMC8896237] [PubMed: 35246190]

25.Tyan P, Abi-Khalil E, Dwarki K, Moawad G. First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities. Case Rep Obstet Gynecol. 2016;2016:3724706. [PMC free article: PMC4978847] [PubMed: 27529043]

26.Panigrahi MK, Kaliaperumal V, Akella A, Venugopal G, Ramadass B. Mapping microbiome-redox spectrum and evaluating Microbial-Redox Index in chronic gastritis. Sci Rep. 2022 May 19;12(1):8450. [PMC free article: PMC9120160] [PubMed: 35589904]

27.Kozlov A, Bean L, Hill EV, Zhao L, Li E, Wang GP. Molecular Identification of Bacteria in Intra-abdominal Abscesses Using Deep Sequencing. Open Forum Infect Dis. 2018 Feb;5(2):ofy025. [PMC free article: PMC5817941] [PubMed: 29479554]

28.Murando F, Peloso A, Cobianchi L. Experimental Abdominal Sepsis: Sticking to an Awkward but Still Useful Translational Model. Mediators Inflamm. 2019;2019:8971036. [PMC free article: PMC6915118] [PubMed: 31885502]

29.Yoon YK, Kim J, Moon C, Lee MS, Hur J, Lee H, Kim SW. Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study. J Korean Med Sci. 2019 Dec 09;34(47):e309. [PMC free article: PMC6900408] [PubMed: 31808326]

30.Große K, Ohm D, Würstle S, Brozat JF, Schmid RM, Trautwein C, Stallmach A, Bruns T, Reuken PA. Clinical characteristics and outcome of patients with enterococcal liver abscess. Sci Rep. 2021 Nov 15;11(1):22265. [PMC free article: PMC8593075] [PubMed: 34782684]

31.Stultz JS, Benefield E, Lee KR, Bashqoy F, Pakyz AL. A Multicenter Analysis of Changes in Pediatric Antibiotic Susceptibilities Among Staphylococcus aureus and Pseudomonas aeruginosa Isolates: 2014-2018. J Pediatr Pharmacol Ther. 2022;27(4):330-339. [PMC free article: PMC9088438] [PubMed: 35558344]

32.Vogelaers D, Blot S, Van den Berge A, Montravers P., Abdominal Sepsis Study (‘AbSeS’) Group on behalf of the Trials Group of the European Society of Intensive Care Medicine. Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units. Drugs. 2021 Jun;81(9):1065-1078. [PubMed: 34037963]

33.Bassetti M, Eckmann C, Giacobbe DR, Sartelli M, Montravers P. Post-operative abdominal infections: epidemiology, operational definitions, and outcomes. Intensive Care Med. 2020 Feb;46(2):163-172. [PubMed: 31701205]

34.Nakano Y, Endo Y, Kitago M, Nishiyama R, Yagi H, Abe Y, Hasegawa Y, Hori S, Tanaka M, Shimane G, Soga S, Egawa T, Okuda S, Kitagawa Y. Clinical characteristics and predictive factors of postoperative intra-abdominal abscess after distal pancreatectomy. Langenbecks Arch Surg. 2023 May 02;408(1):170. [PubMed: 37127833]

35.Akpinar EO, Ghaferi AA, Liem RSL, Bonham AJ, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ., Dutch Audit for Treatment of Obesity (DATO) Research Group. Predicting serious complication risks after bariatric surgery: external validation of the Michigan Bariatric Surgery Collaborative risk prediction model using the Dutch Audit for Treatment of Obesity. Surg Obes Relat Dis. 2023 Mar;19(3):212-221. [PubMed: 36274015]

36.Lin YJ, Ho TW, Wu CH, Kuo TC, Yang CY, Wu JM, Tien YW. Specific Bile Microorganisms Caused by Intra-Abdominal Abscess on Pancreaticoduodenectomy Patients: A Retrospective Cohort Study. Curr Oncol. 2021 Dec 27;29(1):111-121. [PMC free article: PMC8774444] [PubMed: 35049683]

37.Mao BP, Collins G, Ayeni FE, Vagg DJ. Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study. Langenbecks Arch Surg. 2024 Aug 09;409(1):246. [PMC free article: PMC11315757] [PubMed: 39120614]

38.Cirocchi R, Afshar S, Shaban F, Nascimbeni R, Vettoretto N, Di Saverio S, Randolph J, Zago M, Chiarugi M, Binda GA. Perforated sigmoid diverticulitis: Hartmann’s procedure or resection with primary anastomosis-a systematic review and meta-analysis of randomised control trials. Tech Coloproctol. 2018 Oct;22(10):743-753. [PubMed: 29995173]

39.Fillman H, Riquelme P, Sullivan PD, Mansoor AM. Aseptic abscess syndrome. BMJ Case Rep. 2020 Oct 29;13(10) [PMC free article: PMC7597475] [PubMed: 33122231]

40.Simsek A. Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis. Wounds. 2021 Sep;33(9):226-230. [PubMed: 34734841]

41.Fei YF, Lawrence AE, McCracken KA. Tubo-Ovarian Abscess in Non-Sexually Active Adolescent Girls: A Case Series and Literature Review. J Pediatr Adolesc Gynecol. 2021 Jun;34(3):328-333. [PubMed: 33340647]

42.Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Tubo-ovarian abscess. Am J Emerg Med. 2022 Jul;57:70-75. [PubMed: 35525160]

43.Chen CY, Lin MJ, Yang WC, Chang YJ, Gao FX, Wu HP. Clinical spectrum of intra-abdominal abscesses in children admitted to the pediatric emergency department. J Microbiol Immunol Infect. 2020 Apr;53(2):283-291. [PubMed: 30150137]

44.Boyko VV, Riga AS. Type 2 diabetes mellitus – IL-8 and IL-10 profile in patients with intraabdominal postoperative abscesses. Wiad Lek. 2020;73(2):220-223. [PubMed: 32248148]

45.Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, Bartoletti M, Bassetti M, Boncagni F, Carlini M, Cattelan AM, Cavaliere A, Ceresoli M, Cipriano A, Cortegiani A, Cortese F, Cristini F, Cucinotta E, Dalfino L, De Pascale G, De Rosa FG, Falcone M, Forfori F, Fugazzola P, Gatti M, Gentile I, Ghiadoni L, Giannella M, Giarratano A, Giordano A, Girardis M, Mastroianni C, Monti G, Montori G, Palmieri M, Pani M, Paolillo C, Parini D, Parruti G, Pasero D, Pea F, Peghin M, Petrosillo N, Podda M, Rizzo C, Rossolini GM, Russo A, Scoccia L, Sganga G, Signorini L, Stefani S, Tumbarello M, Tumietto F, Valentino M, Venditti M, Viaggi B, Vivaldi F, Zaghi C, Labricciosa FM, Abu-Zidan F, Catena F, Viale P. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg. 2024 Jun 08;19(1):23. [PMC free article: PMC11162065] [PubMed: 38851757]

46.Göbel T, Rauen-Vossloh J, Hotz HG, Boldt A, Erhardt A. [Conservative treatment of an aseptic abscess syndrome with splenic abscesses in Crohn’s disease]. Z Gastroenterol. 2017 Dec;55(12):1313-1317. [PubMed: 29212102]

47.Lentz J, Tobar MA, Canders CP. Perihepatic, Pulmonary, and Renal Abscesses Due to Spilled Gallstones. J Emerg Med. 2017 May;52(5):e183-e185. [PubMed: 28174034]

48.Kim K, Kim E, Lee JH. Clinical spectrum of intra-abdominal abscesses in patients admitted to the emergency department. Australas Emerg Care. 2020 Mar;23(1):6-10. [PubMed: 31926960]

49.Kim SK, Ko SH, Jeong KY, Lee JS, Choi HS, Hong HP. Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess. J Emerg Med. 2021 Mar;60(3):e49-e52. [PubMed: 33303274]

50.Alharbi O, Almadi MA, Azzam N, Aljebreen AM, AlAmeel T, Schreiber S, Mosli MH. Clinical characteristics, natural history, and outcomes of Crohn’s-related intra-abdominal collections. Saudi J Gastroenterol. 2021 Mar-Apr;27(2):79-84. [PMC free article: PMC8183360] [PubMed: 33723092]

51.Capolupo GT, Mascianà G, Carannante F, Caricato M. Hepatic portal venous gas after colonoscopy: A case report and review. Int J Surg Case Rep. 2018;51:54-57. [PMC free article: PMC6107896] [PubMed: 30144710]

52.D’Souza N, Nugent K. Appendicitis. Am Fam Physician. 2016 Jan 15;93(2):142-3. [PubMed: 26926413]

53.Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis. 2023 Jun 30;38(1):182. [PubMed: 37389666]

54.Okui J, Ueno R, Matsui H, Uegami W, Hayashi H, Miyajima T, Kusanagi H. Early prediction model of organ/space surgical site infection after elective gastrointestinal or hepatopancreatobiliary cancer surgery. J Infect Chemother. 2020 Sep;26(9):916-922. [PubMed: 32360091]

55.Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg. 2018 Jun 01;84(6):1015-1021. [PubMed: 29981641]

56.Zens TJ, Rogers AP, Riedesel EL, Leys CM, Ostlie DJ, Woods MA, Gill KG. The cost effectiveness and utility of a “quick MRI” for the evaluation of intra-abdominal abscess after acute appendicitis in the pediatric patient population. J Pediatr Surg. 2018 Jun;53(6):1168-1174. [PubMed: 29673611]

57.Guizzetti L, Zou G, Khanna R, Dulai PS, Sandborn WJ, Jairath V, Feagan BG. Development of Clinical Prediction Models for Surgery and Complications in Crohn’s Disease. J Crohns Colitis. 2018 Jan 24;12(2):167-177. [PMC free article: PMC5881746] [PubMed: 29028958]

58.Hannan MN, Sharma AK, Baran TM. First in human measurements of abscess cavity optical properties and methylene blue uptake prior to photodynamic therapy by in vivo diffuse reflectance spectroscopy. J Biomed Opt. 2024 Feb;29(2):027002. [PMC free article: PMC10898190] [PubMed: 38414658]

59.Ribak R, Schonman R, Sharvit M, Schreiber H, Raviv O, Klein Z. Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements. J Minim Invasive Gynecol. 2020 Feb;27(2):541-547. [PubMed: 31479751]

60.Bakopoulos A, Tsilimigras DI, Syriga M, Koliakos N, Ntomi V, Moris D, Bistarakis D, Schizas D. Diverticulitis of the transverse colon manifesting as colocutaneous fistula. Ann R Coll Surg Engl. 2018 Aug 16;100(8):e1-e3. [PMC free article: PMC6204519] [PubMed: 30112933]

61.Yoshioka T, Kondo Y, Fujiwara T. Successful wound treatment using negative pressure wound therapy without primary closure in a patient undergoing highly contaminated abdominal surgery. Surg Case Rep. 2018 Aug 01;4(1):85. [PMC free article: PMC6070448] [PubMed: 30069647]

62.Commander CW, Wilson SB, Bilaj F, Isaacson AJ, Burke CT, Yu H. CT-Guided Percutaneous Drainage Catheter Placement in the Abdomen and Pelvis: Predictors of Outcome and Protocol for Follow-up. J Vasc Interv Radiol. 2020 Apr;31(4):667-673. [PubMed: 32113797]

63.Ukweh ON, Alswang JM, Iya-Benson JN, Naif A, Chan SM, Laage-Gaupp F, Asch M, Ramalingam V. Comparative Analysis of Percutaneous Drainage versus Operative Drainage of Intra-Abdominal Abscesses in a Resource-Limited Setting: The Tanzanian Experience. Ann Glob Health. 2023;89(1):35. [PMC free article: PMC10237249] [PubMed: 37273489]

64.Okita Y, Mohri Y, Kobayashi M, Araki T, Tanaka K, Inoue Y, Uchida K, Yamakado K, Takeda K, Kusunoki M. Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery. Surg Today. 2013 Oct;43(10):1095-102. [PMC free article: PMC3779006] [PubMed: 23408085]

65.Gorter RR, Meiring S, van der Lee JH, Heij HA. Intervention not always necessary in post-appendectomy abscesses in children; clinical experience in a tertiary surgical centre and an overview of the literature. Eur J Pediatr. 2016 Sep;175(9):1185-1191. [PMC free article: PMC5005384] [PubMed: 27511046]

66.Tian Y, Yao Y, Zhou J, Diao X, Chen H, Cai K, Ma X, Wang S. Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients. Front Med (Lausanne). 2021;8:744907. [PMC free article: PMC8826444] [PubMed: 35155461]

67.Huston JM, Barie PS, Dellinger EP, Forrester JD, Duane TM, Tessier JM, Sawyer RG, Cainzos MA, Rasa K, Chipman JG, Kao LS, Pieracci FM, Colling KP, Heffernan DS, Lester J., Therapeutics and Guidelines Committee. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surg Infect (Larchmt). 2024 Aug;25(6):419-435. [PubMed: 38990709]

68.Bonomo RA, Chow AW, Edwards MS, Humphries R, Tamma PD, Abrahamian FM, Bessesen M, Dellinger EP, Goldstein E, Hayden MK, Kaye KS, Potoski BA, Rodríguez-Baño J, Sawyer R, Skalweit M, Snydman DR, Pahlke S, Donnelly K, Loveless J. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People. Clin Infect Dis. 2024 Oct 04;79(Supplement_3):S81-S87. [PubMed: 38965057]

69.Holt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). J Hepatobiliary Pancreat Sci. 2015 Jan;22(1):12-5. [PubMed: 25159523]

70.Bufalari A, Giustozzi G, Moggi L. Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta Chir Belg. 1996 Sep-Oct;96(5):197-200. [PubMed: 8950379]

71.Morita S, Kamimura K, Suda T, Oda C, Hoshi T, Kanefuji T, Yagi K, Terai S. Endoscopic ultrasound-guided transmural drainage for subphrenic abscess: report of two cases and a literature review. BMC Gastroenterol. 2018 Apr 27;18(1):55. [PMC free article: PMC5921389] [PubMed: 29699494]

72.Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2022 Jun;23(5):417-429. [PMC free article: PMC9208856] [PubMed: 35612434]

73.Hwang JH, Kim BW, Kim SR, Kim JH. The prediction of surgical intervention in patients with tubo-ovarian abscess. J Obstet Gynaecol. 2022 Jan;42(1):97-102. [PubMed: 33629630]

74.Vinodhini P, Sureshkumar S, Gurushankari B, Mahalakshmy T, Kate V. Comparison of Short-Course and Conventional Antimicrobial Duration in Mild and Moderate Complicated Intra-Abdominal Infections: A randomised controlled trial. Sultan Qaboos Univ Med J. 2023 May;23(2):212-219. [PMC free article: PMC10292598] [PubMed: 37377823]

75.Svetanoff WJ, Talukdar N, Dekonenko C, Dorman RM, Osuchukwu O, Fraser JD, Oyetunji TA, St Peter SD. Intra-abdominal Abscess After Appendectomy-Are Drains Necessary in All Patients? J Surg Res. 2020 Oct;254:384-389. [PubMed: 32535257]

76.Qian S, Vasileiou G, Pust GD, Zakrison T, Rattan R, Zielinski M, Ray-Zack M, Zeeshan M, Namias N, Yeh DD., EAST Appendicitis Study Group. Prophylactic Drainage after Appendectomy for Perforated Appendicitis in Adults: A Post Hoc Analysis of an EAST Multi-Center Study. Surg Infect (Larchmt). 2021 Oct;22(8):780-786. [PubMed: 33877912]

77.Mali J, Mentula P, Leppäniemi A, Sallinen V. Determinants of treatment and outcomes of diverticular abscesses. World J Emerg Surg. 2019;14:31. [PMC free article: PMC6615185] [PubMed: 31320921]

78.Dien Esquivel MF, Belaghi R, Webster R, Shapira-Zalstberg G. Image-guided abscess drainage in children with perforated appendicitis – can it wait? Pediatr Radiol. 2023 Oct;53(11):2229-2234. [PubMed: 37553458]

79.Moreno-Alfonso JC, Molina Caballero A, Pérez Martínez A. Antibiotic treatment of post-appendectomy abscesses in children, regardless of size: a twelve years’ experience. Updates Surg. 2023 Dec;75(8):2267-2272. [PubMed: 37794218]

80.Arezzo A, Nicotera A, Bonomo LD, Olandese F, Veglia S, Ferguglia A, Pentassuglia G, Mingrone G, Morino M. Outcomes of surgical treatment of diverticular abscesses after failure of antibiotic therapy. Updates Surg. 2023 Jun;75(4):855-862. [PMC free article: PMC10284947] [PubMed: 37093495]

81.Ocaña J, García-Pérez JC, Fernández-Martínez D, Aguirre I, Pascual I, Lora P, Espin E, Labalde-Martínez M, León C, Pastor-Peinado P, López-Domínguez C, Muñoz-Plaza N, Valle A, Dujovne P, Alías D, Pérez-Santiago L, Correa A, Carmona M, Díez MM, Timoteo A, Salvans S, Medina RE, Gómez T, Fernández-Vega L, Peña E, García-González JM, Blanco-Antona F, Fábregues AI, Sagarra E, Viejo E, Moreno A, Fernández-Cebrián JM, Die J., DIPLICAB Study Collaborative Group. Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. Surgery. 2023 Sep;174(3):492-501. [PubMed: 37385866]

82.Collard MK, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corté H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche R, Vicaut E, Panis Y, Brouquet A. A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn’s Disease: A Subgroup Analysis of a Nationwide Prospective Cohort. J Crohns Colitis. 2021 Mar 05;15(3):409-418. [PubMed: 33090205]

83.Sun Y, Liu W, Ma Y, Yang H, Li Y, Tan B, Li J, Qian J. Computerized tomography features acting as predictors for invasive therapy in the management of Crohn’s disease-related spontaneous intra-abdominal abscess: experience from long-term follow-up. BMC Med Imaging. 2024 Nov 05;24(1):300. [PMC free article: PMC11536533] [PubMed: 39501173]

84.Perl D, Waljee AK, Bishu S, Higgins PDR, Wasnik AP, Stidham RW. Imaging Features Associated With Failure of Nonoperative Management of Intraabdominal Abscesses in Crohn Disease. Inflamm Bowel Dis. 2019 Nov 14;25(12):1939-1944. [PMC free article: PMC6855277] [PubMed: 31294779]

85.Celentano V, Giglio MC, Pellino G, Rottoli M, Sampietro G, Spinelli A, Selvaggi F., Italian Society of Colorectal Surgery SICCR. High complication rate in Crohn’s disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study. Int J Colorectal Dis. 2022 Jun;37(6):1421-1428. [PMC free article: PMC9167187] [PubMed: 35599268]

86.El-Hussuna A, Karer MLM, Uldall Nielsen NN, Mujukian A, Fleshner PR, Iesalnieks I, Horesh N, Kopylov U, Jacoby H, Al-Qaisi HM, Colombo F, Sampietro GM, Marino MV, Ellebæk M, Steenholdt C, Sørensen N, Celentano V, Ladwa N, Warusavitarne J, Pellino G, Zeb A, Di Candido F, Hurtado-Pardo L, Frasson M, Kunovsky L, Yalcinkaya A, Tatar OC, Alonso S, Pera M, Granero AG, Rodríguez CA, Minaya A, Spinelli A, Qvist N. Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn’s disease. BJS Open. 2021 Sep 06;5(5) [PMC free article: PMC8438259] [PubMed: 34518869]

87.Yuan Y, Tang Y, Liu Y, Ren P. A Low Prognostic Nutritional Index Level, an Independent Predictor for Postoperative Intra-abdominal Abscess After Laparoscopic Appendectomy. Surg Laparosc Endosc Percutan Tech. 2024 Dec 01;34(6):603-606. [PubMed: 39358825]

88.Smith AA, Cone JT, McNickle AG, Mitchao DP, Kostka R, Martinez B, Schroeppel T, Cavalea A, Shahan CP, Axtman B, Braverman MA., Multi-Institutional Trial Liver Study Group. MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma. J Surg Res. 2024 Mar;295:746-752. [PubMed: 38147760]

89.Farvacque G, Guilbaud T, Loundou AD, Scemamma U, Berdah SV, Moutardier V, Chirica M, Risse O, Girard E, Birnbaum DJ. Delayed post-pancreatectomy hemorrhage and bleeding recurrence after percutaneous endovascular treatment: risk factors from a bi-centric study of 307 consecutive patients. Langenbecks Arch Surg. 2021 Sep;406(6):1893-1902. [PubMed: 33758966]

90.Zheng S, Christy K, Herzak K, Kobal N, Novak M, Young J, Miyasaka E. Labs Do Not Predict Postoperative Intra-abdominal Abscess in Pediatric Perforated Appendicitis. J Surg Res. 2023 May;285:20-25. [PubMed: 36638551]

91.Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, Rickard J, Zheng B, Liu H, Shi Q, Zhao S, Wang Z, Liu X, Luo Z, Yang K, Chen Y, Sawyer RG. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg. 2023 Mar 29;18(1):24. [PMC free article: PMC10061899] [PubMed: 36991507]

92.Jen J, Hwang R, Mattei P. Post-discharge antibiotics do not prevent intra-abdominal abscesses after appendectomy in children. J Pediatr Surg. 2023 Feb;58(2):258-262. [PubMed: 36428182]

93.Muñoz-Serrano AJ, Delgado-Miguel C, Núñez Cerezo V, Barrena Delfa S, Velayos M, Estefanía-Fernández K, Miguel Ferrero M, Martínez L. Does time to antibiotic initiation and surgery have an impact on acute appendicitis results? Cir Pediatr. 2020 Apr 01;33(2):65-70. [PubMed: 32250068]

94.Podda M, Ceresoli M, Di Martino M, Ortenzi M, Pellino G, Pata F, Ielpo B, Murzi V, Balla A, Lepiane P, Tamini N, De Carlo G, Davolio A, Di Saverio S, Cardinali L, Botteri E, Vettoretto N, Gelera PP, De Simone B, Grasso A, Clementi M, Meloni D, Poillucci G, Favi F, Rizzo R, Montori G, Procida G, Recchia I, Agresta F, Virdis F, Cioffi SPB, Pellegrini M, Sartelli M, Coccolini F, Catena F, Pisanu A. Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study. Surg Endosc. 2024 Jun;38(6):3180-3194. [PMC free article: PMC11133057] [PubMed: 38632117]

95.Frediani S, Aloi IP, Krzysztofiak A, D’Angelo T, Bertocchini A, Madafferi S, Accinni A, Pardi V, Inserra A. The Intraperitoneal Use of Cephazolin: A Novelty in the Prevention of Intra-abdominal Abscess after Laparoscopic Appendectomy in Children. Ann Ital Chir. 2024;95(2):253-256. [PubMed: 38684488]

96.Wee JJ, Park CJ, Lee YT, Cheong YL, Rai R, Nah SA. A simple classification of peritoneal contamination in perforated appendicitis predicts surgery-related complications. J Paediatr Child Health. 2020 Feb;56(2):272-275. [PubMed: 31410904]

97.Araim F, Shmelev A, Kowdley GC. Incidence of Complicated Appendicitis as a Metric of Health Care Delivery. Am Surg. 2022 Apr;88(4):597-607. [PubMed: 33242987]

98.Vaghiri S, David SO, Sultani AB, Safi SA, Knoefel WT, Prassas D. Clinical relevance of the 3-cm threshold in sigmoid diverticulitis with abscess: consensus or quandary? Int J Colorectal Dis. 2024 Jul 12;39(1):106. [PMC free article: PMC11245413] [PubMed: 38995320]

99.Sueda T, Tei M, Yoshikawa Y, Furukawa H, Matsumura T, Koga C, Wakasugi M, Miyagaki H, Kawabata R, Tsujie M, Hasegawa J. Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis. Int J Colorectal Dis. 2020 Mar;35(3):413-422. [PubMed: 31897647]

100.Okui J, Obara H, Uno S, Sato Y, Shimane G, Takeuchi M, Kawakubo H, Kitago M, Okabayashi K, Kitagawa Y. Adverse effects of long-term drain placement and the importance of direct aspiration: a retrospective cohort study. J Hosp Infect. 2023 Jan;131:156-163. [PubMed: 36370963]

101.Hu A, Li J, Vacek J, Bouchard M, Ingram MC, McMahon M, Mithal LB, Raval MV, Reynolds M, Goldstein S. Antibiotic resistance is common in the cultures of intraabdominal abscess drainage after appendectomy. J Pediatr Surg. 2022 Sep;57(9):102-106. [PubMed: 34991867]

102.Byerly SE, Filiberto DM, Lenart EK, Easterday T, Howley I, Nouer S, Tolley E, Magnotti LJ. Clinical decompensation after trauma laparotomy: It’s probably not a pulmonary embolus. Injury. 2024 Sep;55(9):111651. [PubMed: 38849214]

103.Lorente-Herce JM, Parra-Membrives P, Martínez-Baena D, Cañete-Gómez J, Segura-Sampedro JJ. Influence of surgical site infection on oncological prognosis after curative resection for colorectal cancer: An observational single-institution study. Cir Cir. 2021;89(5):574-582. [PubMed: 34665164]

104.Vaghiri S, Prassas D, Mustafov O, Kalmuk S, Knoefel WT, Lehwald-Tywuschik N, Alexander A, Dizdar L. Which factors predict tumor recurrence and survival after curative hepatectomy in hepatocellular carcinoma? Results from a European institution. BMC Surg. 2024 Apr 08;24(1):101. [PMC free article: PMC11003056] [PubMed: 38589847]

105.Matsui R, Inaki N, Tsuji T, Fukunaga T. Relationship Between Fat Mass Indices and Postoperative Complications After Laparoscopic Gastrectomy in Patients With Gastric Cancer: A Propensity Score Matching Analysis. Anticancer Res. 2022 Oct;42(10):4841-4848. [PubMed: 36191993]

106.Kolck J, Hosse C, Beetz NL, Auer TA, Marth AA, Segger L, Krenzien F, Lurje G, Pelzer U, Geisel D, Schöning W, Fehrenbach U. Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients. Cancer Rep (Hoboken). 2024 Sep;7(9):e2070. [PMC free article: PMC11425665] [PubMed: 39324689]

107.Wang H, Jin J, Zhu F, Peng F, Wang M, Qin R. The ratio of abdominal depth to body mass index is a preoperative predictor of postoperative complications after laparoscopic pancreaticoduodenectomy: a retrospective propensity score matched analysis. Surg Endosc. 2021 Dec;35(12):6472-6480. [PubMed: 33156385]

108.Furukawa A, Furukawa K, Suzuki D, Yoshitomi H, Takayashiki T, Kuboki S, Miyazaki M, Ohtsuka M. Effect of immunonutrition on infectious complications in low skeletal muscle mass patients after pancreaticoduodenectomy. Clin Nutr. 2021 Jan;40(1):103-109. [PubMed: 32402682]

109.Yamamoto T, Nakahigashi M, Shimoyama T, Umegae S. Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn’s disease? A case-matched study. Colorectal Dis. 2020 May;22(5):554-561. [PubMed: 31782874]

110.Jeong O, Jang A, Jung MR, Kang JH, Ryu SY. The benefits of enhanced recovery after surgery for gastric cancer: A large before-and-after propensity score matching study. Clin Nutr. 2021 Apr;40(4):2162-2168. [PubMed: 33069509]

111.Fukuhara S, Kobayashi T, Hamaoka M, Naruhiko H, Oishi K, Namba Y, Oshita KO, Matsubara K, Takei D, Nakano R, Sakai H, Kuroda S, Tahara H, Ohira M, Ohdan H. Sarcopenia’s Impact Defined by Grip Strength and Muscle Mass on Post-hepatectomy Outcomes: A Multicenter Analysis. In Vivo. 2024 Nov-Dec;38(6):2827-2835. [PMC free article: PMC11535901] [PubMed: 39477404]

112.Holubar SD, Hedrick T, Gupta R, Kellum J, Hamilton M, Gan TJ, Mythen MG, Shaw AD, Miller TE., Perioperative Quality Initiative (POQI) I Workgroup. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery. Perioper Med (Lond). 2017;6:4. [PMC free article: PMC5335800] [PubMed: 28270910]

113.Seifarth C, Kreis ME, Gröne J. Indications and Specific Surgical Techniques in Crohn’s Disease. Viszeralmedizin. 2015 Aug;31(4):273-9. [PMC free article: PMC4608647] [PubMed: 26557836]

114.Zani A, Hall NJ, Rahman A, Morini F, Pini Prato A, Friedmacher F, Koivusalo A, van Heurn E, Pierro A. European Paediatric Surgeons’ Association Survey on the Management of Pediatric Appendicitis. Eur J Pediatr Surg. 2019 Feb;29(1):53-61. [PubMed: 30112745]

Disclosure: Nisarg Mehta declares no relevant financial relationships with ineligible companies.

Disclosure: Mia Marietta declares no relevant financial relationships with ineligible companies.

Disclosure: Eddie Copelin II declares no relevant financial relationships with ineligible companies.