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Diagnosis Scanning procedures have considerably facilitated the diagnosis of intraabdominal abscesses. Abdominal CT probably has the highest yield, although ultrasonography is particularly useful for the right upper quadrant, kidneys, and pelvis. Both indium-labeled WBCs and gallium tend to localize in abscesses and may be useful in finding a collection. Since gallium is taken up in the bowel, indium-labeled WBCs may have a slightly greater yield for abscesses near the bowel. Neither indium-labeled WBC nor gallium scans serve as a basis for a definitive diagnosis, however; both need to be followed by other, more specific studies, such as CT, if an. | Chapter 121. Intraabdominal Infections and Abscesses Part 6 Diagnosis Scanning procedures have considerably facilitated the diagnosis of intraabdominal abscesses. Abdominal CT probably has the highest yield although ultrasonography is particularly useful for the right upper quadrant kidneys and pelvis. Both indium-labeled WBCs and gallium tend to localize in abscesses and may be useful in finding a collection. Since gallium is taken up in the bowel indium-labeled WBCs may have a slightly greater yield for abscesses near the bowel. Neither indium-labeled WBC nor gallium scans serve as a basis for a definitive diagnosis however both need to be followed by other more specific studies such as CT if an area of possible abnormality is identified. Abscesses contiguous with or contained within diverticula are particularly difficult to diagnose with scanning procedures. Occasionally a barium enema may detect a diverticular abscess not diagnosed by other procedures although barium should not be injected if a perforation is suspected. If one study is negative a second study sometimes reveals a collection. Although exploratory laparotomy has been less commonly used since the advent of CT this procedure still must be undertaken on occasion if an abscess is strongly suspected on clinical grounds. Intraperitoneal Abscesses Treatment An algorithm for the management of patients with intraabdominal including intraperitoneal abscesses is presented in Fig. 121-3. The treatment of intraabdominal infections involves the determination of the initial focus of infection the administration of broad-spectrum antibiotics targeting the organisms involved and the performance of a drainage procedure if one or more definitive abscesses have formed. Antimicrobial therapy in general is adjunctive to drainage and or surgical correction of an underlying lesion or process in intraabdominal abscesses. Unlike the intraabdominal abscesses resulting from most causes for which drainage of some kind is .
