History and exam
Key diagnostic factors
common
recent history of surgery, trauma, or intra-abdominal infection
Patients with recent abdominal surgery, trauma requiring laparotomy, and common intra-abdominal infections (appendicitis, diverticulitis) are all at risk for IAA.[1] Patients who require intestinal resection and anastomosis are at particular risk for anastomotic leak (1.5%) and abdominal abscess formation.[16]
fever or hypothermia
A potential sign of sepsis, though nonspecific; should prompt further investigations, especially in those with known intra-abdominal pathology or recent surgery or instrumentation. In older and immunocompromised patients, hypothermia is common with IAA.
abdominal pain
Common in patients with IAA related to perforated appendicitis and diverticulitis. Pain can present as focal tenderness or generalized nonspecific abdominal pain. In postoperative patients, pain may be masked by surgical incision or postoperative narcotic use. It could be differentiated from postsurgical or incisional pain by the fact that it does not improve with time.
uncommon
rectal tenderness and fullness
Pararectal abscess or low pelvic abscess may present with rectal tenderness on digital rectal exam.
Other diagnostic factors
common
tachycardia
Mild tachycardia is common but is usually multifactorial.
change in bowel habits/abnormal bowel function
Nonspecific symptom, but ileus, obstipation, or diarrhea may occur.
prolonged ileus
Prolonged ileus, although nonspecific, should raise suspicion of IAA.
anorexia/lack of appetite
More likely to be associated with appendicitis but could be associated with intra-abdominal infection.
nausea and vomiting
Patients may have accompanying symptoms of nausea and vomiting, as well as chills and night sweats.
uncommon
palpable mass
More frequent with appendicitis or diverticulitis in a thin person.
signs of sepsis
Depending on individual systemic inflammatory response, patients may present with sepsis or septic shock. May also occur early after drainage of an IAA.
Presentation ranges from subtle, nonspecific symptoms (e.g., feeling unwell with a normal temperature) to severe symptoms with evidence of multi-organ dysfunction and septic shock. Patients may have signs of tachycardia, tachypnea, hypotension, fever or hypothermia, poor capillary refill, mottled or ashen skin, cyanosis, newly altered mental state or reduced urine output.[20]
preoperative corticosteroid use
Preoperative corticosteroid use has been associated with an increased risk of intra-abdominal sepsis after surgery for Crohn disease.[27]
Risk factors
strong
recent surgery or trauma, appendicitis, diverticulitis, or perforated ulcer
Patients with recent abdominal surgery, trauma requiring laparotomy, and common intra-abdominal infections (appendicitis, diverticulitis) are all at risk for IAA.[1] Patients who require intestinal resection and anastomosis are at particular risk for anastomotic leak (1.5%) and abdominal abscess formation.[16]
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