Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 Jul;212(1):60–65. doi: 10.1097/00000658-199007000-00009

Intra-abdominal abscess after blunt abdominal trauma.

W A Goins 1, A Rodriguez 1, M Joshi 1, D Jacobs 1
PMCID: PMC1358075  PMID: 2363605

Abstract

The relationship between blunt abdominal trauma and intra-abdominal abscess (IAA) is discussed infrequently; therefore we conducted a retrospective review of 4050 multiple blunt trauma admissions from January 1986 to July 1988. Of 325 patients who had a laparotomy for blunt abdominal trauma, we identified 15 (4.6%) who had 40 IAAs. The most common intra-abdominal injuries involved the spleen and liver. Splenectomy increased the risk for IAA in contrast to splenic salvage. Blunt injuries to the kidney and pancreas, when occurring in multiple trauma patients, carried a significant risk of IAA. Associated multiple extra-abdominal injuries and high transfusion requirements increased the risk for IAA formation. Most of the IAAs were located in the upper quadrants. There was a 46% incidence of multiple IAA, which in turn had an 80% chance of recurrence after initial drainage. Enterobacter species played an important role in the formation of IAA in our trauma patients. Three patients (20%) died. Poor prognostic indicators included a high injury severity score, high transfusion requirements, the presence of pelvic fracture, positive blood cultures, multiple organisms per abscess, and multiple-organ system failure.

Full text

PDF
62

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aeder M. I., Wellman J. L., Haaga J. R., Hau T. Role of surgical and percutaneous drainage in the treatment of abdominal abscesses. Arch Surg. 1983 Mar;118(3):273–280. doi: 10.1001/archsurg.1983.01390030005001. [DOI] [PubMed] [Google Scholar]
  2. Altemeier W. A., Culbertson W. R., Fullen W. D., Shook C. D. Intra-abdominal abscesses. Am J Surg. 1973 Jan;125(1):70–79. doi: 10.1016/0002-9610(73)90010-x. [DOI] [PubMed] [Google Scholar]
  3. Bunt T. J. Non-directed relaparotomy for intra-abdominal sepsis. A futile procedure. Am Surg. 1986 Jun;52(6):294–298. [PubMed] [Google Scholar]
  4. Butler J. A., Huang J., Wilson S. E. Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors. Arch Surg. 1987 Jun;122(6):702–706. doi: 10.1001/archsurg.1987.01400180084016. [DOI] [PubMed] [Google Scholar]
  5. Connell T. R., Stephens D. H., Carlson H. C., Brown M. L. Upper abdominal abscess: a continuing and deadly problem. AJR Am J Roentgenol. 1980 Apr;134(4):759–765. doi: 10.2214/ajr.134.4.759. [DOI] [PubMed] [Google Scholar]
  6. Dellinger E. P., Oreskovich M. R., Wertz M. J., Hamasaki V., Lennard E. S. Risk of infection following laparotomy for penetrating abdominal injury. Arch Surg. 1984 Jan;119(1):20–27. doi: 10.1001/archsurg.1984.01390130010002. [DOI] [PubMed] [Google Scholar]
  7. Deveney C. W., Lurie K., Deveney K. E. Improved treatment of intra-abdominal abscess. A result of improved localization, drainage, and patient care, not technique. Arch Surg. 1988 Sep;123(9):1126–1130. doi: 10.1001/archsurg.1988.01400330106016. [DOI] [PubMed] [Google Scholar]
  8. Driver T., Kelly G. L., Eiseman B. Reoperation after abdominal trauma. Am J Surg. 1978 Jun;135(6):747–750. doi: 10.1016/0002-9610(78)90156-3. [DOI] [PubMed] [Google Scholar]
  9. Ellison E. C., Fabri P. J. Complications of splenectomy. Etiology, prevention, and management. Surg Clin North Am. 1983 Dec;63(6):1313–1330. doi: 10.1016/s0039-6109(16)43191-9. [DOI] [PubMed] [Google Scholar]
  10. Feliciano D. V., Mattox K. L., Jordan G. L., Jr, Burch J. M., Bitondo C. G., Cruse P. A. Management of 1000 consecutive cases of hepatic trauma (1979-1984). Ann Surg. 1986 Oct;204(4):438–445. doi: 10.1097/00000658-198610000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ferraris V. A. Exploratory laparotomy for potential abdominal sepsis in patients with multiple-organ failure. Arch Surg. 1983 Oct;118(10):1130–1133. doi: 10.1001/archsurg.1983.01390100004002. [DOI] [PubMed] [Google Scholar]
  12. Fry D. E., Garrison R. N., Heitsch R. C., Calhoun K., Polk H. C., Jr Determinants of death in patients with intraabdominal abscess. Surgery. 1980 Oct;88(4):517–523. [PubMed] [Google Scholar]
  13. Fry D. E. Multiple system organ failure. Surg Clin North Am. 1988 Feb;68(1):107–122. doi: 10.1016/s0039-6109(16)44435-x. [DOI] [PubMed] [Google Scholar]
  14. Fry D. E., Pearlstein L., Fulton R. L., Polk H. C., Jr Multiple system organ failure. The role of uncontrolled infection. Arch Surg. 1980 Feb;115(2):136–140. doi: 10.1001/archsurg.1980.01380020006003. [DOI] [PubMed] [Google Scholar]
  15. Gerzof S. G., Johnson W. C., Robbins A. H., Nabseth D. C. Expanded criteria for percutaneous abscess drainage. Arch Surg. 1985 Feb;120(2):227–232. doi: 10.1001/archsurg.1985.01390260085012. [DOI] [PubMed] [Google Scholar]
  16. Gerzof S. G., Robbins A. H., Johnson W. C., Birkett D. H., Nabseth D. C. Percutaneous catheter drainage of abdominal abscesses: a five-year experience. N Engl J Med. 1981 Sep 17;305(12):653–657. doi: 10.1056/NEJM198109173051201. [DOI] [PubMed] [Google Scholar]
  17. Greenspan L., McLellan B. A., Greig H. Abbreviated Injury Scale and Injury Severity Score: a scoring chart. J Trauma. 1985 Jan;25(1):60–64. doi: 10.1097/00005373-198501000-00010. [DOI] [PubMed] [Google Scholar]
  18. Hau T., Simmons R. L. Mechanisms of the adjuvant effect of hemoglobin in experimental peritonitis. III. The influence of hemoglobin on phagocytosis and intracellular killing by human granulocytes. Surgery. 1980 May;87(5):588–592. [PubMed] [Google Scholar]
  19. Hinsdale J. G., Jaffe B. M. Re-operation for intra-abdominal sepsis. Indications and results in modern critical care setting. Ann Surg. 1984 Jan;199(1):31–36. doi: 10.1097/00000658-198401000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ing A. F., McLean A. P., Meakins J. L. Multiple-organism bacteremia in the surgical intensive care unit: a sign of intraperitoneal sepsis. Surgery. 1981 Oct;90(4):779–786. [PubMed] [Google Scholar]
  21. Ivatury R. R., Zubowski R., Psarras P., Nallathambi M., Rohman M., Stahl W. M. Intra-abdominal abscess after penetrating abdominal trauma. J Trauma. 1988 Aug;28(8):1238–1243. doi: 10.1097/00005373-198808000-00017. [DOI] [PubMed] [Google Scholar]
  22. Jander H. P., Russinovich N. A. Transcatheter gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage. Radiology. 1980 Aug;136(2):337–344. doi: 10.1148/radiology.136.2.6967615. [DOI] [PubMed] [Google Scholar]
  23. Lurie K., Plzak L., Deveney C. W. Intra-abdominal abscess in the 1980s. Surg Clin North Am. 1987 Jun;67(3):621–632. doi: 10.1016/s0039-6109(16)44235-0. [DOI] [PubMed] [Google Scholar]
  24. Moore E. E. Edgar J. Poth Lecture. Critical decisions in the management of hepatic trauma. Am J Surg. 1984 Dec;148(6):712–716. doi: 10.1016/0002-9610(84)90422-7. [DOI] [PubMed] [Google Scholar]
  25. Nichols R. L., Smith J. W., Klein D. B., Trunkey D. D., Cooper R. H., Adinolfi M. F., Mills J. Risk of infection after penetrating abdominal trauma. N Engl J Med. 1984 Oct 25;311(17):1065–1070. doi: 10.1056/NEJM198410253111701. [DOI] [PubMed] [Google Scholar]
  26. Norton L. W. Does drainage of intraabdominal pus reverse multiple organ failure? Am J Surg. 1985 Mar;149(3):347–350. doi: 10.1016/s0002-9610(85)80105-7. [DOI] [PubMed] [Google Scholar]
  27. Polk H. C., Jr, Shields C. L. Remote organ failure: a valid sign of occult intra-abdominal infection. Surgery. 1977 Mar;81(3):310–313. [PubMed] [Google Scholar]
  28. Scott C. M., Grasberger R. C., Heeran T. F., Williams L. F., Hirsch E. F. Intraabdominal sepsis after hepatic trauma. Am J Surg. 1988 Feb;155(2):284–288. doi: 10.1016/s0002-9610(88)80715-3. [DOI] [PubMed] [Google Scholar]
  29. Sims E. H., Mandal A. K., Schlater T., Fleming A. W., Lou M. A. Factors affecting outcome in pancreatic trauma. J Trauma. 1984 Feb;24(2):125–128. doi: 10.1097/00005373-198402000-00006. [DOI] [PubMed] [Google Scholar]
  30. Stone H. H., Fabian T. C., Satiani B., Turkleson M. L. Experiences in the management of pancreatic trauma. J Trauma. 1981 Apr;21(4):257–262. doi: 10.1097/00005373-198104000-00001. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES