Intra-Abdominal, Retroperitoneal, and Visceral Abscesses in Children

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.

Bacteroides: the Good, the Bad, and the Nitty-Gritty

“…One hypothesis to explain a potential pathogenic mechanism is that colonization with ETBF leads to acute or chronic intestinal inflammation (304); also, the enterotoxin may cleave E-cadherin, an intercellular adhesion protein forming the zonula adherens of intestinal epithelial cells (303) (which limits the ability of water or larger molecules to pass between cells), thus leading to the increased permeability of intestinal epithelial cells. In polarized cell monolayers, BFT alters the apical F-actin structure, resulting in disruption of the epithelial barrier function (39), which may consequently contribute to the diarrhea1 disease associated with B. fragilis infection (28).…”

“…A few studies evaluating the microbiology of the peritoneal cavity and postoperative wounds in children following perforated appendix in pediatric patients found that Bacteroides species were recovered from 93% of peritoneal fluids, along with enteric gram-negative bacteria and enterococci (38). Complications following peritonitis may include subphrenic, hepatic, splenic, and retroperitoneal abscesses (39) (which may occur secondary to appendicitis), necrotizing enterocolitis, pelvic inflammatory disease, tubo-ovarian infection, surgery, or trauma (39). B. fragilis was the most common anaerobe found in postsurgical wound infections in wounds relating to the gut flora (37).…”

Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing

“…Among the B. fragilis group, B. fragilis accounts for 40% to 54% of the Bacteroides isolates recovered from intra-abdominal as well as other infections (4,(84)(85)(86). Another important pathogen that belongs to the B. fragilis group is B. thetaiotaomicron, which accounts for 13% to 23% of the isolates.…”

Microbiology and Management of Abdominal Infections

“…The retroperitoneal infections can occur at various sites posterior to the peritoneum [12]. These include four spaces: anterior retroperitoneal (containing the esophagus, duodenum, pancreas, bile duct, portal and splenic veins, appendix, ascending and descending colon, and rectosigmoid), posterior retroperitoneal (or perinephric, containing the kidneys, ureters, gonadal vessels, aorta, inferior cava, and lymph nodes), retrofascial (or ileopsoas, containing the 12th rib, spine, and paraspinous muscle), and pelvic retroperitoneal (containing the prevesical, retrovesical presacral, and perirectal spaces).…”