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Patient case: Intraabdominal Peritonitis and Abscess

Patient case: Intraabdominal Peritonitis and Abscess

Discussion

A 42-year-old male presents to the emergency department with complaints of severe abdominal pain, fever, and nausea that started three days ago. He describes the pain as diffuse, worsening over time, and associated with bloating. His medical history includes a recent laparotomy for a perforated duodenal ulcer two weeks prior. On physical examination, the patient is febrile (39.2°C), tachycardic, and shows signs of abdominal guarding with marked tenderness, particularly in the lower quadrants.

Blood work reveals elevated white blood cell count (WBC 18,000/µL) and elevated inflammatory markers (CRP 150 mg/L). Abdominal ultrasound followed by a CT scan demonstrates fluid collections consistent with an intraabdominal abscess, along with thickening of the bowel wall and free air suggestive of secondary peritonitis.

The patient is diagnosed with secondary peritonitis complicated by an intraabdominal abscess, likely resulting from a leak at the site of the recent surgery. He is started on broad-spectrum intravenous antibiotics and fluid resuscitation. A percutaneous drain is placed under radiological guidance to manage the abscess, and the surgical team is consulted for possible re-exploration if the patient’s condition does not improve.

After several days of intensive management, his fever subsides, and repeat imaging shows resolution of the abscess, with the patient gradually recovering.

Questions
1. What is the most likely cause of the patient's current symptoms?

a). Acute pancreatitis

b). Bowel obstruction

c). Intraabdominal abscess secondary to surgery

d). Cholecystitis

 

 

2. Which of the following imaging techniques confirmed the diagnosis of intraabdominal abscess?

a). X-ray

b). MRI

c). Ultrasound followed by CT scan

d). PET scan

3. What is the initial treatment approach for this patient's condition?

a). Oral antibiotics and discharge

b). Percutaneous drainage and intravenous antibiotics

c). Emergency exploratory laparotomy

d). Laparoscopic surgery immediately

4. What was the most likely source of the peritonitis in this patient?

a). Ruptured appendix

b). Perforated duodenal ulcer with surgical leak

c). Diverticulitis

d). Trauma to the abdomen

Reveal answers

Answers

  1. c). Intraabdominal abscess secondary to surgery
  2. c). Ultrasound followed by CT scan
  3. b). Percutaneous drainage and intravenous antibiotics
  4. b). Perforated duodenal ulcer with surgical leak