Abscess in adults: symptoms, causes and treatment

Surgeon

Bohyan

Tigran Surenovich

Experience 37 years

Surgeon of the highest category, Doctor of Medical Sciences, member of the International Association of Surgeons, Gastroenterologists and Oncologists

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An abscess is an accumulation of purulent contents in various tissues. Purulent inflammation is usually caused by a bacterial infection. In this case, in the process of melting the tissue, a cavity is formed. The occurrence of an abscess is caused by bacteria entering the tissue from the outside - through abrasions and injuries or from other infected tissues and organs. This disease differs from other similar diseases in the formation of a capsule that prevents the spread of inflammation.

Based on the location of the pus, there are superficial accumulations in the subcutaneous fatty area and deep ones inside organs and deep tissues. Depending on the method of penetration of pathogenic microorganisms, there are exogenous accumulations (from the external environment) and endogenous (migration within the body of one person).

Symptoms and signs

Regardless of the location of the purulent accumulation, the symptoms of an abscess are the same:

• intoxication – fever, chills, weakness, malaise, nausea, vomiting, poor appetite, muscle and joint pain, headaches;
• superficial location - redness and swelling of the skin directly above the site of accumulation, pain on palpation or during movement;
• disruption of the functioning of the damaged organ or related tissues.

A chronic abscess does not have symptoms of an acute inflammatory process. Deeply located accumulations have only general signs of intoxication and are detected by instrumental diagnostics. The most common locations of an abscess are:

• inside the bones - the main symptom is pain from physical activity or when the weather changes;
• Lung abscess is manifested by shortness of breath and weak breathing. A lung abscess is often confused with pneumonia;
• in the abdominal cavity and liver is accompanied by signs of any disease of this organ;
• in the brain causes seizures and loss of coordination;
• prostate abscess causes pain when urinating;
• a throat abscess causes cough spasms and pain;
• Bartholin gland abscess and others.

Cold occurs without signs of intoxication and appears in immunodeficiencies. Natechny eliminates the presence of an inflammatory process in tissues. Acute abscess has more pronounced symptoms compared to other forms.

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How common is rectal fistula?

The incidence in European countries is about 10-25 people per 100 thousand population. Mostly people of working age suffer from rectal fistulas. Men get sick 2-3 times more often than women.

Important! This disease, being benign, can dramatically reduce a person’s quality of life. A serious and most common complication of inadequate treatment of perianal fistulas is impaired holding function due to damage to the muscular apparatus of the anal canal.

Causes of occurrence and development

The main cause of an abscess is a bacterial infection that has entered the tissue from the outside world. Bacteria enter the body due to microtraumas that violate the integrity of the skin. Such injuries include cuts and minor abrasions/scratches/damage received during shaving or hair cutting, manicure or pedicure, and others. At the same time, if dirt or small particles in the form of a splinter get in, the likelihood of a purulent accumulation increases.

The occurrence of an accumulation of pus can occur for other reasons for an abscess:

• migration of infection from the primary source of infection;
• festering hematomas and cysts;
• surgical manipulations – violation of sanitary rules in the form of unsterile instruments;
• disturbances during the administration of drugs and preparations, for example, disturbances in concentration during vaccinations.

The abscess develops further under the influence of reduced immunity or poor circulation in the area of ​​the abscess.

Risk factors

Favorable background for the appearance of abscesses are also:

• long-term diseases of the gastrointestinal tract (gastroenteritis, enteritis, colitis);
• peripheral circulatory disorders (atherosclerosis, varicose veins, postthrombophlebitis disease);
• metabolic disorders (obesity, hypothyroidism, vitamin deficiency).

Diabetes mellitus with severe damage to the blood vessels plays a particularly significant role in the development and progression of the purulent process.

Forms of the disease and routes of infection

An abscess can be an independent disease, but in the vast majority of cases it appears as a complication of an underlying disease, for example, purulent tonsillitis causes a peritonsillar abscess. Pathogenic microorganisms have a lot of ways to get inside - through damage to the skin as a result of injuries and cuts, from other organs and tissues that were previously infected, through non-sterile equipment during surgical procedures, and others.

Forms of the disease are classified according to the location of purulent accumulation:

• retropharyngeal abscess;
• peripharyngeal;
• peritonsillar abscess;
• subdiaphragmatic;
• soft tissues;
• periodontal;
• appendicular and others.

Classification

Doctors describe different forms of the disease based on the source of the inflammatory process. It is very important to establish the localization of the abscess in the early stages of diagnosis for effective surgical treatment.

Basic forms:

• Metastatic abscess is the formation of a secondary pyogenic capsule containing pus as a result of the spread of infection from distant sites. Bacteria and fungal microorganisms can spread through the blood and lymph flow.
• Postoperative ulcers are pathological areas formed as a result of surgical treatment of diseases. In this case, the pathology may be caused by a failed interintestinal anastomosis, infection, or an error during removal of the appendix.
• Perforated abscess. The inflammatory focus is formed as a result of rupture of the walls of the inflamed anatomical structure. This could be a rupture of the walls of the appendix, pancreas due to pancreatic necrosis, or another organ.
• Post-traumatic abscess resulting from trauma to the abdominal organs.

Imaging and diagnostic procedures can help determine the source of inflammation.

Complications

In the absence of timely and adequate treatment, complications of abscesses are very dangerous for the life and health of the patient:

• phlegmon;
• neuritis;
• osteomelitis;
• internal bleeding of the walls of blood vessels;
• peritonitis,
• sepsis as a result of purulent abscess of the appendicular region;
• purulent meningitis and others.

Contacting the clinic

A purulent accumulation is fraught with dangerous consequences, therefore, if the slightest sign of the presence of an accumulation of pus in tissues or organs appears, you should immediately consult a doctor. The ideal solution would be to call an ambulance.

At (academician Roitberg’s clinic) you will receive the necessary assistance in treatment. In addition, JSC “Medicine” (academician Roitberg’s clinic) has the ability to accommodate patients in a 24-hour hospital and has the function of calling a doctor at home around the clock.

Diagnostics

Purulent accumulations located near the surface of the skin are easily diagnosed during an external examination based on characteristic signs. A throat abscess is detected during examination by an otolaryngologist.

Diagnosis of an abscess located deep inside requires special laboratory and instrumental studies:

• a biochemical blood test will show the inflammatory process in the body with an increased content of leukocytes and ESR, as well as shifts in protein fractions;
• radiography is used to detect subdiaphragmatic, intraosseous and pulmonary collections;
• Ultrasound is aimed at identifying accumulations in the abdominal cavity and liver;
• computed tomography, as an auxiliary method, detects purulent accumulations in the brain, lungs and liver, subdiaphragmatic region and inside bones and joints;
• encephalography of various forms (echo-, electro-, pneumo-) is aimed at studying the brain;
• laparoscopy and angihepatography are used as an auxiliary method for examining the liver;
• puncture of the abscess and culture of its contents are performed to determine the specific type of pathogen and its sensitivity to certain antibacterial drugs.

Most often, purulent accumulations are caused by streptococci, staphylococci in combination with various kinds of bacilli, but now other aerobic and anaerobic bacteria are also becoming widespread.

Treatment

The key to successful treatment of an abscess lies in its timely detection. This is why it is so important to immediately consult a doctor if you have any symptoms.

Treatment principles:

• Only superficial purulent accumulations can be treated at home under the supervision of a doctor. All other cases require hospitalization;
• opening and drainage of the area of ​​purulent accumulation is carried out by a surgeon; it is necessary to remove the abscess;
• drug therapy is based on taking the following drugs: antibacterial agents, antipyretics, painkillers, drugs to reduce intoxication, vitamin complexes, immunomodulators and others;
• balanced nutrition, gentle bed or semi-bed rest, and rest;
• physical therapy, physiotherapy and sanatorium-resort treatment are possible as rehabilitation measures during the recovery stage.

Special ointments are used as adjuncts in the treatment of subcutaneous fatty suppuration.

Purulent accumulations in the lungs are initially treated with broad-spectrum antibiotics, and after receiving the results of culture culture studies, adjustments are made to the medications taken. In severe cases, bronchoalveolar lavage may be performed. If there is no positive effect of classical therapy, an abscess operation is forced to remove the affected part of the organ.

Treatment of purulent accumulations in the brain is carried out using surgical methods. Contraindications for removal of accumulations, namely the location in the deep parts of the brain, necessitates washing out the purulent contents by puncture. Treatment of purulent accumulations at home using traditional medicine is unacceptable.

results

A method has been developed to improve the technique of percutaneous drainage with a stylet catheter under ultrasound guidance by infiltrating the interloop tissue (intestinal mesentery, omentum) with an anesthetic solution. Injecting fluid into the adjacent tissue allows you to increase the space for acoustic access, displacing the intestinal wall, and outline the drainage path, bypassing large vessels and the intestinal wall and thereby avoiding their damage.

Drainage was performed in 103 patients. The duration of the manipulation was 20±8.2 minutes. In 97 of 103 patients, one intervention was required to adequately drain the cavity. In 6 cases, additional drainage was performed on days 3–11 due to the insufficient effectiveness of primary drainage. In 3 patients, repeated drainage was performed on the 60th day after surgery due to failure of the intestinal anastomosis and failure to close the internal fistula. Cure occurred in 101 (98%) patients within 10–73 days. Mortality rate was 1.9% ( n

=2). A 53-year-old patient died from pulmonary embolism 2 months after undergoing surgery (laparoscopic gastrectomy for stomach cancer, gastric bleeding). The second patient, 74 years old, died due to adhesive intestinal obstruction, which required surgical intervention - laparotomy, adhesiolysis. The course of the postoperative period was complicated by multiple intestinal fistulas, abdominal abscesses, and suppuration of the postoperative wound. In none of the cases was repeated open drainage of the abscess required. In 2 cases of the formation of external intestinal fistulas in the postoperative period, obstructive intestinal resection was required.

The results of dynamic ultrasound and fistulography were analyzed. It was revealed that in 67% the data coincided, which makes it possible to abandon fistulography at the final stage of treatment if the clinical course is positive. Therefore, only ultrasound is sufficient to assess the residual cavity. In addition, ultrasound-guided drainage is an effective independent method of treating abscesses associated with hollow organs without additional interventions to close the fistula.