An abdominal abscess is a localized collection of pus within the abdominal cavity, most often caused by bacterial infection. Onset can be gradual or rapid, and clinical presentations differ by site and size, but several typical features are usually present.
- Fever and chills
A swinging or spiking fever is common, frequently accompanied by chills or rigors as the body responds to ongoing infection . - Abdominal pain
Persistent, deep-seated pain is the hallmark. It may be dull or sharp, localized or diffuse, and often intensifies on movement, coughing, or palpation . - Gastro-intestinal upset
Nausea, vomiting, loss of appetite, and sometimes constipation are frequent associated symptoms, especially when the abscess lies near bowel loops . - Swollen or tender abdomen
Visible distension and guarding may develop; palpation reveals localized tenderness or a vaguely defined tender mass . - Referred pain
A sub-diaphragmatic collection can produce shoulder-tip pain or chest discomfort on the affected side, particularly during inspiration . - Systemic signs
Tachycardia, elevated blood pressure, and leukocytosis often accompany the fever. If sepsis supervenes, hypotension and altered mental status may appear . - Specific local features
- Pelvic abscess: rectal or vaginal fullness, frequent or painful urination.
- Sub-phrenic abscess: hiccups, basal lung crackles, or pleural rub.
- Psoas abscess: flexion deformity of the hip and pain on hip extension.
Early recognition is crucial; delayed drainage can lead to spontaneous rupture, peritonitis, or septic shock.
| Key Symptom / Sign | Description |
|---|---|
| Fever & chills | Swinging temperature, often > 38 °C, with rigors |
| Abdominal pain | Constant, worsens on movement or palpation |
| GI upset | Nausea, vomiting, anorexia, constipation |
| Abdominal swelling | Localized mass or generalized distension with tenderness |
| Referred pain | Shoulder, chest, or back pain for sub-diaphragmatic collections |
| Systemic toxicity | Tachycardia, high WBC, possible hypotension |
| Emergency red flags | Rising fever, uncontrolled pain, hypotension, altered sensorium |