Can an intra-abdominal abscess cause urinary retention?

Intra-abdominal Abscess as a Cause of Urinary Retention

Yes, intra-abdominal abscesses can cause urinary retention through direct compression of the bladder or urinary tract structures. This is documented in clinical guidelines and case reports, though it is not among the most common presentations of intra-abdominal abscesses.

Mechanism and Evidence

Urinary retention can occur as a complication of intra-abdominal abscesses through several mechanisms:

• Direct compression: Abscesses located in the pelvis or lower abdomen can exert pressure on the bladder or urethra
• Local inflammation: Inflammatory processes can affect nearby urinary tract structures
• Mass effect: Large abscesses can cause displacement of pelvic organs

According to the World Journal of Emergency Surgery guidelines, anorectal abscesses may occasionally present with urinary retention 1. This occurs when the abscess is large enough or positioned in a way that obstructs normal urinary outflow.

Clinical Presentation

When an intra-abdominal abscess causes urinary retention, patients may present with:

• Inability to void or incomplete bladder emptying
• Suprapubic discomfort or pain
• Palpable distended bladder
• Frequent unsuccessful attempts to urinate

A case report in Cureus documented a 53-year-old male with a four-day history of urinary retention without perirectal pain who was found to have a perirectal abscess on digital rectal examination 2. This demonstrates that urinary retention can sometimes be the primary presenting symptom of an abscess, even in the absence of typical abscess symptoms.

Diagnostic Approach

When evaluating urinary retention potentially caused by an intra-abdominal abscess:

1. Digital rectal examination is crucial to identify anorectal abscesses 1
2. Imaging studies (particularly CT scan) are the most effective for diagnosing and localizing intra-abdominal abscesses 3
3. Urinary catheterization may be necessary for immediate relief while addressing the underlying cause

Management Considerations

Treatment should address both the urinary retention and the underlying abscess:

1. Urinary drainage: Placement of a urinary catheter (suprapubic or transurethral) to relieve the retention
2. Abscess management:
   • Small abscesses (<3 cm): May be treated with antibiotics alone 4
   • Larger abscesses (>3 cm): Require drainage (percutaneous or surgical) plus antibiotics 4

Special Considerations

• Perirectal abscesses specifically have been documented to cause urinary retention, as noted in the WSES-AAST guidelines 1
• Prostatic abscesses can also cause urinary retention and may require transrectal ultrasound-guided aspiration 5
• Diverticular abscesses have been reported to cause acute urinary retention that was initially misdiagnosed as prostatitis 6

Follow-up and Monitoring

After initial management:

• Monitor for resolution of both the abscess and urinary symptoms
• Follow-up imaging may be necessary to confirm abscess resolution
• Continue antibiotics until clinical signs of infection have resolved

Pitfalls to Avoid

1. Misdiagnosis: Urinary retention due to intra-abdominal abscess may be misattributed to more common causes like benign prostatic hyperplasia
2. Delayed diagnosis: Absence of typical abscess symptoms (pain, fever) may delay recognition
3. Inadequate treatment: Focusing only on urinary drainage without addressing the underlying abscess

In summary, while not the most common presentation, intra-abdominal abscesses should be considered in the differential diagnosis of urinary retention, particularly when other symptoms of infection are present or when more common causes have been ruled out.