Visceral Abscess - Causes, Symptoms, and Treatment

Introduction

A visceral abscess is the collection of pus within the organs of the abdominal cavity, like the liver or spleen. It can be due to an infection directly affecting the organ or as a complication of any other medical condition. It is a condition that requires prompt medical attention since it can lead to the development of sepsis or organ failure.

What Is a Visceral Abscess?

An intra-abdominal abscess is the accumulation of pus within the peritoneal cavity.

This can be of three types which include:

• Intra-Peritoneal Abscess - Abscess of the peritoneal cavity (space surrounding the organs).

• Retroperitoneal Abscess - Abscess of the retroperitoneal region (space between the posterior abdominal wall and peritoneum). This region contains organs like the kidney and pancreas.

• Visceral Abscess - Formation of an abscess within the organs like the liver and spleen.

What Are the Causes of Visceral Abscess?

A visceral abscess occurs due to the spread of infection through blood or lymph. It can also occur secondarily as a complication of a medical condition in the body.

Some of the common etiological factors are:

• Infections: Infectious organisms can reach the internal organs by hematogenous route or spread locally from adjacent structures of the peritoneal cavity.

The microbes commonly involved are:

• Bacteria like Escherichia coli, Klebsiella, Bacillus fragilis, Streptococcus, Staphylococcus aureus.

• Parasites like Entamoeba histolytica and Echinococcus granulosus.

• Fungi like Candida and Aspergillus.

Infections spreading from other organs include:

• Appendicitis with rupture and pylephlebitis (suppurative thrombosis of the portal vein) can cause subsequent infection in the liver, resulting in liver abscess.

• Bacterial endocarditis can lead to a splenic abscess.

Medical conditions that cause visceral abscesses include:

• Conditions like colonic diverticulitis, a biliary tract disease, can result in a visceral abscess.

• Patients who have received immunosuppressive therapy for malignancy of the spleen and patients with hemoglobinopathies or hematological disorders like sickle cell anemia are highly prone to develop splenic abscesses.

What Are the Signs and Symptoms of Visceral Abscess?

The signs and symptoms of visceral abscess are based on the location, extent, and causative factor.

• Fever: The most common presenting sign of a visceral abscess is fever. This is often accompanied by night chills.

Some non-specific symptoms include:

• Nausea.

• Vomiting.

• Anorexia.

• Weight loss.

• Loss of appetite.

• Generalized fatigue.

• Pain: A liver abscess can cause localized pain and swelling in the right upper quadrant, while a splenic abscess can cause pain in the left upper quadrant.

• Enlargement of the liver and spleen (hepatomegaly and splenomegaly) occurs in about 50 % of patients.

• Patients with liver abscesses are prone to develop jaundice.

How Is a Visceral Abscess Diagnosed?

The diagnosis of a visceral abscess is made by a combination of laboratory tests and physical and radiographic examination.

Laboratory Investigations:

• Hematological tests show elevated white blood cells (WBC) and erythrocyte sedimentation rate (ESR).

• The diagnostic laboratory finding of liver abscess is elevated alkaline phosphatase levels. In some cases, elevated bilirubin and aspartate aminotransferase levels are noted.

• There is an increase in the levels of inflammatory markers like C-Reactive protein.

Physical Examination:

Physical examination of the abdomen can elicit any tenderness in the left or right upper quadrant to diagnose the abscess site.

Radiographic Examination:

• It is the most reliable diagnostic method for visceral abscesses. It includes using ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI).

• CT scan of the abdomen is the most sensitive diagnostic tool.

These tests can help in locating and determining the size of the abscess. In some cases, needle biopsy or aspiration of the abscess can help diagnose visceral abscesses.

What Is the Treatment of Visceral Abscess?

A visceral abscess is treated by a combination of surgical and medical approaches. The treatment depends on several factors, including the location and size of the abscess.

Drainage:

• The mainstay of treatment is the drainage of the abscess.

• Percutaneous drainage is recommended in case of smaller-sized abscesses, while open surgical drainage is done for large abscesses.

• In the case of a splenic abscess, splenectomy with adjuvant antibiotic therapy remains the standard treatment protocol.

• Surgical management is essential if there is extensive damage to the surrounding tissues due to a visceral abscess.

Antibiotics:

• The choice of antibiotic used depends on the causative microorganism and its sensitivity.

• Broad-spectrum antibiotics are given as a first-line treatment. This includes using Penicillin, cephalosporins, or fluoroquinolones.

• Specific antibiotics are administered only after the identification of the microbe. Metronidazole is generally given for anaerobic bacteria and Vancomycin for gram-positive bacteria.

• Abscesses of fungal origin are initially treated with Amphotericin B and subsequently with Fluconazole therapy.

The duration of antibiotic treatment may vary depending on the severity of the infection, the location and size of the abscess, and the response to treatment. Antibiotic treatment is usually continued for several days or weeks. In addition, the patient may need to be monitored with blood tests and imaging to ensure the infection responds to treatment.

Treating an Underlying Medical Condition:

If a visceral abscess is caused due to an underlying medical condition like appendicitis or disease of the biliary duct, the condition should be treated along with the visceral abscess.

What Are the Complications of a Visceral Abscess?

A visceral abscess can lead to several complications, especially if left untreated or if treatment is delayed. Some of the potential complications of a visceral abscess include:

1. Sepsis: It occurs when the body's immune system goes into overdrive in response to an infection. This can cause widespread inflammation and organ damage and can be life-threatening.

2. Organ Failure: If the abscess is located near a vital organ, such as the liver, lungs, or kidneys, it can lead to organ damage or failure.

3. Rupture: In some cases, the abscess may rupture, causing the pus and bacteria to spread throughout the body and potentially leading to sepsis.

4. Fistula Formation: A fistula is an abnormal connection between two organs or tissues. A visceral abscess can cause a fistula to form, leading to further infections and complications.

5. Chronic Infection: If the abscess is not completely treated, it can lead to a chronic infection that may require long-term antibiotics or repeated drainage procedures.

6. Death: In severe cases, a visceral abscess can be life-threatening and may lead to death if not treated promptly and effectively.

It is essential to seek medical attention to prevent complications and ensure proper treatment.

Conclusion

Prevention of a visceral abscess includes good hygiene, prompt treatment of infections, and management of underlying conditions that may increase the risk of abscess formation. Regular medical check-ups and monitoring of chronic conditions can also help prevent the development of a visceral abscess.