Peritoneal abscess

　　Peritoneal abscess is a common surgical abdominal disease. The site of onset of peritoneal abscess is below the diaphragm, pelvic cavity, and interintestinal space. Peritoneal abscesses generally occur secondary to acute peritonitis or various diseases that cause secondary peritonitis, abdominal surgery, and trauma. Primary infection is rare. Peritoneal abscesses are classified into subdiaphragmatic abscesses, pelvic abscesses, and interintestinal abscesses. The etiology and pathogenesis are as follows:

　　1. Subdiaphragmatic abscess

　　Any accumulation of pus below the diaphragm is called a subdiaphragmatic abscess. Subdiaphragmatic abscess is the most important type of abdominal abscess. It is a severe complication of peritonitis. Once infection forms an abscess below the diaphragm, it must be treated through surgical drainage.

　　2. Pelvic abscess

　　The pelvis is located at the lowest part of the peritoneum, and inflammatory exudates in the abdominal cavity are prone to accumulate here, which is the most common complication of abdominal infection.

　　3. Intercystic abscess

　　The pus is surrounded by the intestine, mesentery, and omentum, which can form one or more abscesses of different sizes. Due to the extensive adhesions around the abscess, adhesive ileus of varying degrees often occurs, and if the abscess penetrates into the intestine or bladder, it forms an internal fistula, and the pus is excreted with feces and urine.

　　An abdominal abscess refers to a localized accumulation of pus in a certain space or location within the abdominal cavity, which is surrounded by loops of intestine, visceral organs, abdominal wall, omentum, or mesentery due to necrosis and liquefaction of tissue, forming a localized collection of pus.

　　The most common complication of abdominal abscesses is secondary infection. After the treatment of intra-abdominal organ inflammation, or after the removal of the stomach or spleen, if the body temperature of the patient drops and then rises again, it should be considered that there may be an infection below the diaphragm. Patients often present with remittent fever as the main symptom, around 39℃, accompanied by excessive sweating, anorexia, fatigue, and general malaise.

　　Persistent dull pain in the upper abdomen on the affected side, which may radiate to the shoulder and back, worsens with deep breathing or coughing, and sometimes is accompanied by hiccups. During physical examination, there may be deep tenderness and percussion pain on the upper abdomen or back on the affected side, and in severe cases, local skin indentation edema may occur.

　　There are many causes of abdominal abscesses, generally secondary to acute peritonitis or various diseases that cause secondary peritonitis. Abdominal abscesses can be divided into subdiaphragmatic abscesses, pelvic abscesses, and interloop abscesses, with different symptoms in different locations:

　　1. Subdiaphragmatic abscess

　　Systemic symptoms: Fever is a common symptom of subdiaphragmatic abscess, characterized by persistent high fever, rapid pulse, and thick, greasy tongue coating. Then, general fatigue, weakness, night sweats, anorexia, and weight loss begin to appear. Blood tests may show a significant increase in white blood cell count, with an increased proportion of neutrophils.

　　Local symptoms: The affected area may have persistent dull pain, which can worsen with deep breathing. The pain is often located below the ribs and under the xiphoid process. If the abscess is located below the liver and towards the back, it can cause renal pain, and sometimes the pain can radiate to the neck and shoulder. Stimulation of the diaphragm by the abscess can cause hiccups. Infections below the diaphragm can cause pleural and pulmonary reactions through the lymphatic system, leading to pleural effusion, cough, and chest pain. If the abscess ruptures into the pleural cavity, it can cause empyema. In recent years, due to the widespread misuse of antibiotics, the local symptoms of abdominal abscesses are often atypical. In severe cases, local skin indentation edema may occur, with local skin becoming hot and the temperature rising. Breathing on the affected side may show a smaller range of chest wall movement, with less pronounced intercostal spaces compared to the healthy side. The liver dullness border may expand and rise. About 25% of patients have gas in the abscess cavity, which can produce four different sound areas when percussed.

　　2. Pelvic abscess

　　The area of the pelvic peritoneum is small, and its ability to absorb toxins is poor, therefore, the systemic symptoms of pelvic abscess are relatively mild while the local symptoms are relatively prominent. In the treatment process of acute peritonitis, in patients with appendiceal perforation or postoperative colon and rectum, if the body temperature is normal and then rises again, and typical rectal or bladder irritation symptoms appear, such as tenesmus (a feeling that feces cannot be fully evacuated), frequent and small stools, stools mixed with mucus, frequent urination, urgency, dysuria, difficulty in urination, etc., then it should be considered that there may be a pelvic abscess. The abdomen usually has no obvious symptoms. Digital rectal examination may find relaxation of the anal sphincter muscle, palpation of rectal distension in the anterior wall of the rectum, tenderness, and sometimes fluctuation.

　　3. Interloop abscess

　　Patients with interloop abscess often show symptoms of purulent infection, as the infection focus is relatively closed and isolated, it rarely causes systemic reactions, and the fever symptoms are not as obvious as the above two types of abdominal abscesses, and are mostly low fever. However, the symptoms and signs of the abdomen are relatively prominent. Patients often have localized abdominal pain, mostly dull pain, with discomfort such as abdominal distension. Physical examination may show abdominal tenderness and palpable abdominal mass. If the abscess breaks into the intestinal tract or bladder, an internal fistula may form, and pus can be excreted with feces and urine. In addition, interloop abscess can also cause mechanical intestinal obstruction, with symptoms such as abdominal pain, abdominal distension, vomiting, cessation of flatus and defecation, etc.

　　Abdominal abscess includes subdiaphragmatic abscess, pelvic abscess, and interloop abscess. Various diseases that cause secondary peritonitis, abdominal surgery, and trauma after injury can lead to this disease. The etiology is complex and is the result of the combined action of multiple factors. The key to preventing this disease is to treat the primary disease.

　　Abdominal abscess refers to a localized abscess in a certain space or location within the abdominal cavity, which is surrounded by intestinal loops, visceral organs, abdominal wall, omentum, or mesentery due to tissue necrosis and liquefaction. The laboratory tests that need to be done include:

　　1. B-ultrasound examination

　　It is of great significance in the diagnosis of abdominal abscesses, which can clearly determine the location and size of the abscess. Under the guidance of B-ultrasound, puncture of the abscess can be performed, and dynamic monitoring can also play a guiding role in treatment.

　　2. X-ray examination

　　Under fluoroscopy, it can be found that the movement of the diaphragm on the affected side is limited, the chest X-ray film often shows elevation of the diaphragm on the affected side, blurring of the costodiaphragmatic angle, or pleural effusion. Sometimes, an occupying shadow can be seen below the diaphragm, or a liquid-gas interface outside the stomach.

　　3. CT examination

　　CT has an important value in determining the location, size, and relationship with adjacent organs of the abscess, and can also be used to guide puncture during the procedure.

　　4. Abdominal puncture

　　By puncturing the abscess site, the aspirated pus can be sent for bacteriological and drug sensitivity tests, which not only achieves the therapeutic effect but also guides medication.

　　5. Posterior fornix puncture

　　For female patients with pelvic mass considering abscess, posterior fornix puncture is more accurate and less likely to cause injury to abdominal visceral organs.

What is good to eat for abdominal abscess?

　　1. Abdominal abscess food therapy recipe:

　　Medicinal part: the whole grass of Sonchus oleraceus.

　　Flavor and meridian entry: Bitter, cold. ① 'Shen Nong's Materia Medica': 'Bitter in flavor, cold.' ② 'Bie Lu': 'Non-toxic.' Enters the heart, spleen, stomach, and large intestine meridians; ① 'Materia Medica': 'Enters the heart, spleen, and stomach meridians.' ② 'True to Its Nature': 'Enters the heart, stomach, and large intestine meridians.' Effects and indications: Clear heat, cool blood, detoxify, improve eyesight, harmonize the stomach, and relieve cough. Treat dysentery, jaundice, hematuria, hemorrhoids, carbuncle, snake bite, cough, bronchitis, malnutrition.

　　Usage and dosage: Internal use: decocted in water, juiced or ground into powder. External use: mashed and applied to the skin or decocted water for fumigation and washing.

　　Taboo of medicine: ① 'Materia Medica': 'People with deficiency-cold of the spleen and stomach'

　　Traditional Chinese medicine treatment should use methods such as clearing heat and detoxifying, activating blood circulation and dissipating blood stasis, and reducing swelling and dissipating masses. The main traditional Chinese medicine prescriptions are for conservative treatment of abdominal abscess. Traditional Chinese medicine divides abdominal abscess into two types: heat-toxin and blood stasis obstruction type and dampness and turbidity obstruction type, and uses different prescriptions accordingly:

　　1. Heat-toxin and blood stasis obstruction type

　　Treatment is based on clearing heat and detoxifying, and dissipating blood stasis and swelling.

　　Prescription: 3 grams of Manis pentadactyla, 3 grams of Thlaspi arvense, 3 grams of Angelica sinensis, 3 grams of Licorice, 9 grams of Lonicera japonica, 3 grams of Red Peony, 3 grams of Frankincense, 3 grams of Trichosanthes kirilowii, 9 grams of Citrus reticulata, 3 grams of Saposhnikovia divaricata, 3 grams of Fritillaria thunbergii, 3 grams of Magnolia officinalis.

　　If there is a lot of leukorrhea, yellowish and smelly taste, add 10 grams of Phellodendron amurense and 30 grams of Coix seed to clear dampness and heat.

　　2. Dampness and turbidity obstruction type

　　Treatment is based on promoting diuresis and regulating Qi, activating blood circulation and dissipating masses. The formula uses Tuoliu Xiaodu Powder with modifications.

　　Prescription: 15 grams of Codonopsis, 15 grams of Astragalus, 10 grams of Licorice, 10 grams of Atractylodes macrocephala, 15 grams of Poria, 10 grams of Angelica sinensis, 12 grams of Red Peony, 25 grams of Lonicera japonica, 10 grams of Magnolia officinalis, 10 grams of Platycodon grandiflorus, 10 grams of Sarcoscypha coccinea.

　　If there is a low fever, add 15 grams of Houttuynia cordata and 10 grams of Dandelion to clear heat and detoxify.