Symptoms of Peritoneal Abscess
A peritoneal abscess presents with abdominal pain and tenderness (occurring in 74-95% of patients), often accompanied by fever, tachycardia, and signs of peritoneal irritation including rebound tenderness and guarding. 1
Core Clinical Manifestations
The hallmark symptoms of peritoneal abscess include:
- Abdominal pain and tenderness - present in 74-95% of patients, representing the most consistent finding 1
- Rebound tenderness and guarding - indicating peritoneal irritation 1
- Abdominal rigidity - strongly suggests the presence of peritonitis 1
- Fever - temperature greater than 38.5°C occurs in 38% of patients 1
- Tachycardia - observed in 62.5% of patients 1
Additional Clinical Features
Beyond the cardinal symptoms, patients may present with:
- Decreased bowel sounds - a common finding suggesting ileus 1
- Ileus symptoms - including vomiting and absence of defecation 1
- Abdominal distension - seen in 6.6% of patients as an isolated finding 1
- Rectal bleeding - observed in 15% of patients 1
Systemic Signs of Severity
When infection progresses, look for:
- Hemodynamic instability and shock - indicating severe sepsis 1
- Hypotension and hypoperfusion signs - including lactic acidosis, oliguria, and altered mental status, which indicate ongoing sepsis 1
Laboratory Abnormalities
Supporting laboratory findings include:
- Leukocytosis - occurs in 40% of patients, often with a left shift (band neutrophils >20%) 1
- Elevated C-reactive protein (CRP) 1
- Elevated serum lactate levels 1
- Increased serum creatinine - more than 50% above baseline in some patients 1
Important Clinical Context
The diagnosis is primarily based on clinical assessment, especially in resource-limited settings. 1 However, imaging can confirm the diagnosis when clinical findings are equivocal. CT scan has the highest sensitivity and specificity for detecting peritonitis and associated abscesses compared to ultrasound and plain X-ray. 1
Critical Pitfall to Avoid
Delay in diagnosis and treatment significantly increases mortality rates, especially in patients with diffuse peritonitis. 1 The key is recognizing that abdominal pain with peritoneal signs (rebound, guarding, rigidity) in a patient with recent bacterial tonsillitis should raise immediate concern for a serious intra-abdominal process requiring urgent evaluation and source control. 2, 1
Note that while peritonsillar abscess can have serious complications including descending mediastinitis and deep neck infections 3, direct extension to cause intra-abdominal/peritoneal abscess would be extraordinarily rare and would require hematogenous spread or other unusual mechanisms.