Intra-Abdominal, Retroperitoneal, and Visceral Abscesses in Children

 

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Abstract

This review describes the microbiology, diagnosis, and management of intra-abdominal abscesses (including subphrenic, hepatic, splenic, and retroperitoneal abscesses) in children. They often occur as a complication of local or generalized peritonitis, commonly secondary to appendicitis, necrotizing enterocolitis, pelvic inflammatory disease, and tubo-ovarian infection, surgery or trauma. The original infection generally occurs because of the entry of enteric microorganisms into the peritoneal cavity through a defect in the wall of the intestine or other viscus as a result of obstruction, infarction, or direct trauma. Mixed aerobic and anaerobic flora can be recovered from most abscesses. The predominant aerobic isolates are Escherichia coli, Staphylococcus aureus, and Enterococcus spp. and the main anaerobic bacteria are Bacteroides fragilis group Peptostreptococcus spp., Fusobacterium spp., and Clostridium spp. The treatment of intraabdominal abscesses includes drainage, surgical correction of pathology, and administration of antimicrobials effective against both aerobic and anaerobic microorganisms.

Résumé

Cette revue décrit la microbiologie, le diagnostic et la prise en charge des abcès intra-abdominaux (incluant les abcès sous-phréniques, hépatiques, spléniques et rétropéritonéaux) chez l'enfant. Ils surviennent souvent comme une complication d'une péritonite locale ou généralisée, le plus souvent secondaire à une appendicite, à une entérocolite nécrosante, à une maladie inflammatoire du pelvis, à une infection tubo-ovarienne, à la chirurgie ou à un traumatisme. Généralement, l'infection survient à cause de l'entrée de micro-organismes dans la cavité péritonéale à travers un défect intestinal ou d'un autre viscère, secondaire à une obstruction, un infarctus ou un traumatisme direct. Une flore aérobie et anaérobie peut être retrouvée dans la majorité des abcès. Les germes le plus souvent retrouvés sont l'Escherichia Coli, le Staphylocoque Doré et l'Entérocoque. La bactérie anaérobie retrouvée le plus fréquemment est le Bacteroïdes Fragilis du groupe des Streptocoques, le Fusobacterium et le Clostridium. Le traitement des abcès intra-abdominaux comporte le drainage, la correction chirurgicale de la pathologie et l'administration d'antibiotiques efficaces contre les aérobies et les anaérobies.

Resumen

Revisamos en este estudio el diagnóstico, tratamiento y hallazgos microbiológicos de los abscesos intraabdominales en niños incluyendo subfrénicos, hepáticos, esplénicos y retroperitoneales. Todos ocurrieron como complicaciones de peritonitis local o generalizada generalmente secundaria a apendicitis, enterocolitis necrotizante, enfermedad inflamatoria pélvica, infección tuboovárica, cirugía o trauma. La infección original se debió en la mayoría de los casos al acceso de microorganísmos entéricos a la cavidad peritoneal a través de un defecto de la pared del intestino o de otras vísceras como resultado de obstrucción, isquemia o trauma directo. Pudimos recuperar flora aerobia, mixta o anaerobia en la mayoría de los abscesos. Los gérmenes predominantes entre los aerobios fueron e. coli, s. aureus y str. spp. Entre los anerobios b. fragilis, peptoespectrococo spp., fusobactrium spp. y clostridium spp. El tratamiento de los abscesos intraabdominales incluye drenaje, corrección quirúrgica de la enfermedad original y administración de antimicrobianos eficaces contra microorganísmos aerobios y anaerobios.

Zusammenfassung

Die Arbeit beschreibt die Mikrobiologie, Diagnose und das Behandlungsverfahren bei intraabdominellen Abszessen einschließlich subphrenischer, Leber-, Milz- und retroperitoneale Abszesse im Kindesalter. Diese Abszesse entstehen häufig als Folge einer lokalen und generalisierten Peritonitis, diese wiederum als Folge einer Appendizitis, nekrotisierenden Enterokolitis, einer Infektion der Tuben oder des Ovars des kleinen Beckens sowie nach anderen chirurgischen Eingriffen, aber auch nach Traumen. Die Infektion erfolgt infolge eines Übertretens von Mikroorganismen des Darmes in die Bauchhöhle, entweder infolge einer direkten Verletzung oder einer Durchwanderung. Die typische mikrobielle Flora ist gemischt aerob und anaerob, wobei die dominierenden Keime Escherichia coli, Staphylococcus aureus, Enterococcus spp. und die wichtigsten anaeroben Keime der Bacteroides fragilis, die Gruppe der Peptostreptococcen spp., der Fusobakterien spp. und der Clostridien spp. sind. Die Behandlung ist bekannt und besteht in einer ausgiebigen Drainage, chirurgischen Beseitigung der zugrunde liegenden Pathologie und der Gabe von Antibiotika entsprechend dem Antibiogramm, wobei sowohl die anaeroben wie die aeroben Keime abgedeckt sein müssen.

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M.D., MSc I. Brook

Department of Pediatrics
Georgetown University School of Medicine

4431 Albemarle St. NW

Washington DC 20016

USA

Email: ib6@georgetown.edu