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pericolic abscess

Etiology: - complication of diverticulitis Radiology: - computed tomography (CT) of abdomen & pelvis [2,3,4] a) severe pain, high fever, palpable mass b) diverticular pericolic abscess vs non-diverticular etiology of abdominal pain - CT-guided drainage of larger abscesses [2] c) low radiation dose without contrast [3] d) diagnosis & guidance of therapy e) imaging modality of choice Management: - if < 2 cm, medical management - intravenous antibiotics - ceftriaxone + metronidazole - ampicillin + aminoglycoside + metronidazole - ampicillin sulbactam (Unasyn) - ticarcillin clavulanate (Timentin) - piperacillin tazobactam (Zosyn) - Imipenem cilastatin (Primaxin) - CT-guided drain placement for pericolic abscesses >= 4 cm in diameter & nonresolving pericolic abscess [1]

General

abdominal abscess

References

  1. NEJM Knowlege+ Question of the Week. Dec 6, 2022 https://knowledgeplus.nejm.org/question-of-week/439/
  2. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Tack D, Bohy P, Perlot I, De Maertelaer V, Alkeilani O, Sourtzis S, Gevenois PA. Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi-detector row CT. Radiology. 2005 Oct;237(1):189-96. Epub 2005 Aug 26. PMID: 16126929
  4. von Strauss und Torney M, Moffa G, Kaech M et al. Risk of emergency surgery or death after initial nonoperative management of complicated diverticulitis in Scotland and Switzerland. JAMA Surg 2020 May 13 PMID: 32401298 Free PMC article https://jamanetwork.com/journals/jamasurgery/fullarticle/2765846