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Factors for localization:
- Pathological factors: Inflammatory, adhesions, slow progress
- Anatomical divisions: Subphrenic, peritoneal cavity proper (supracolic, infracolic), pelvic
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Common sites:
- Primary site: iliac fossa (appendicitis, diverticulitis)
- Pelvic
- Other intraperitoneal: subphrenic, subhepatic, inter-loop
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Clinical features:
- Pain in the area of the involved organ.
- Fever, tachycardia
- Guarding, rigidity & rebound tenderness overlying the involved area.
- Rest of the abdomen non-tender.
- Special features:
- Shoulder tip pain (Subphrenic),
- Both iliac fossa tenderness (Suprapubic)
- Mucoid diarrhea, tenesmus (Pelvic abscess)
- Pelvic abscess: DRE, anterior pelvic tenderness and fullness
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Investigations:
- Labs: CBC, u/e
- Imaging:, AXR, Ultrasound, CT scan-most helpful
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Treatment:
- NPO, IV fluid,
- Antibiotics- polymicrobial cover.
- Percutaneous/ open surgical drainage
- if no resolution or abscess formation
