Fact-sheet: Intestinal abcess - bowel
Updated on 09/17/2021 at 12:16 PM
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Definition
Organized abdominal or pelvic collection of digestive origin, most often secondary to a digestive perforation.
Perianal abscess:
purulent collection secondary to infection of small glands located in the anal canal.
Possible progression to cutaneous fistulization.
Perisigmoid abscess:
follows diverticular perforation on the outer aspect of the sigmoid
Clinical features
Painful inflammatory swelling around the anus
+/- fever
Laboratory findings
Infectious syndrome
CT
Reference examination. After injection: - Organized collection with peripherally enhancing rim - Possible air-fluid level - Possible pneumoperitoneum bubbles indicating digestive perforation - Associated infiltration of the surrounding fat, peritoneal effusion - Search for the cause of the perforation (diverticulum, tumor, foreign body, iatrogenic...) Perianal abscess: perianal collection, search for cutaneous fistulization. Perisigmoid abscess: - Diverticular sigmoid - Irregular sigmoid wall thickening with marked enhancement after injection - Presence of a perforated diverticulum - Infiltration of the perisigmoid fat - Fluid collection within the sigmoid mesentery containing gas bubbles (or air-fluid level), with markedly enhancing irregular rim
Management
Treatment of perianal abscesses is always surgical. Indeed, cure will only be achieved once the fistula tract has been identified and removed. Antibiotic therapy alone can never treat this condition. Perisigmoid abscess: drainage indicated if > 3 cm