Symptoms
The symptoms of a bowel abscess can sometimes vary greatly. Possible symptoms that may indicate an intestinal abscess are abdominal pain or cramps of varying intensity. Nausea, vomiting, fever or a general feeling of illness can also be an indication of a bowel abscess.
However, these are very unspecific symptoms that also occur in the context of a common gastrointestinal infection. Since intestinal abscesses are often found in the context of previous illnesses, specific symptoms of this clinical picture or an aggravation of the clinical picture can indicate the abscess as a complication. Diverticulitis, for example, manifests itself in an acute, left-sided pain in the lower abdomen.
The pain is very severe and worsens over time. Fever is also typical for such an inflammation. Sudden diarrhoea or constipation are also common symptoms.
Unfortunately, the symptoms are often very mild, especially in older people. There is therefore a risk that the abscess will not be recognized as such. A bursting of the abscess can even lead to an initial improvement in symptoms.
After some time, however, the symptoms worsen again and severe abdominal pain, nausea and vomiting occur. Shock with unconsciousness is also a possible consequence. In appendicitis, an abscess can easily hide the symptoms of the inflammation.
It is not at all uncommon in such a case that only a fever and a slight pressure pain in the right lower abdomen is noticeable. This is what makes the abscess so dangerous in appendicitis. An intestinal abscess can, but need not necessarily, cause pain.
Often it is unspecific abdominal pain, which is difficult to assign to an exact cause. However, intestinal abscesses occur very rarely in otherwise healthy individuals. In most cases there is a pre-existing condition where intestinal abscesses are possible complications. Newly occurring abdominal pain is therefore examined more closely in such persons, as there is a higher risk of complications. However, an intestinal abscess can also cause severe abdominal or abdominal pain, which is why those affected go directly to an emergency room.
Treatment
A bowel abscess is a serious complication that must be treated promptly. If an abscess is not treated, it can burst and have serious consequences that are potentially life-threatening. Treatment of a bowel abscess includes surgery and antibiotic therapy.
The aim of the operation is to remove and clear out the abscess. The antibiotic therapy is intended to prevent infection and further inflammation. The surgical procedure is selected according to the underlying previous illness and the type of abscess.
In principle, both minimally invasive and open surgical procedures are possible. In a minimally invasive operation, the surgical instruments are inserted into the abdomen through small incisions. For an open operation, on the other hand, an abdominal incision is made.
The abscess is cleared out and, if necessary, parts of the intestine are also removed if this is necessary. During such an operation it may be necessary to create an artificial bowel outlet temporarily. This is the case, for example, in complicated diverticulitis.
The bowel outlet is then relocated back into the abdomen after a few weeks. For antibiotic therapy, antibiotics are used to combat germs that are mainly found in the intestine. These include the antibiotics metronidazole, cefuroxime, ciprofloxacin or piperacillin and tazobactam.
Usually two or more antibiotics are combined to fight as many germs as possible. Apart from the specific therapy of the abscess, the underlying disease in which the abscess occurred must also be treated. In the case of Crohn’s disease, for example, a so-called remission maintenance must be carried out after the operation on the abscess.
This maintenance of remission includes treatment with drugs that are intended to prevent a relapse of the disease. These include glucocorticoids, which are similar to the body’s own cortisone and have an anti-inflammatory effect, as well as so-called immunosuppressants, which downregulate the activity of the immune system. In special cases, as an alternative to the surgical relief of the abscess, a drainage (see section Drainage) can be placed in the abscess to drain it.
The intestinal abscess must be relieved and emptied surgically to prevent potentially life-threatening complications. An abscess can burst at any time. The probability of this increases from day to day.
Abscesses are removed both in emergency operations and in planned operations. If an abscess has already burst, surgery is also necessary to cleanse the abdomen of the abscess contents and remove any inflamed or dead intestinal tissue. Depending on the type of intestinal abscess, pre-existing intestinal diseases and individual course, the appropriate surgical technique is selected.
In some cases, a minimally invasive procedure can be selected, in which the surgical instruments are inserted into the abdomen through small incisions. In a conventional operation, the abdominal cavity is opened with an abdominal incision in order to reach the intestine. Heavily inflamed parts of the intestine, for example in the case of appendicitis or diverticulitis, are also removed during such an operation.
It may also be necessary to temporarily create an artificial bowel outlet. However, this is more likely to be the case with very complicated procedures. In the course of the operation, the artificial bowel outlet is moved back into the abdominal cavity in a second operation.
After the operation, patients usually have to be taken to an intensive care unit. A hospital stay of about 14 days or longer is normal after such an operation. As an alternative to surgery, in some cases a drainage can be placed in the abscess to drain the abscess contents into a container.
The drain is placed in the right place using an ultrasound machine or CT imaging. This procedure is also known as sonography or CT-guided. Nevertheless, an operation is usually performed to remove the entire abscess, including its capsule and any inflamed parts of the bowel. One reason for the prior insertion of a drainage can be a very poor general condition of the patient, which makes an immediate operation too risky.
