A pelvic abscess is loculated purulent material in the pelvic cavity and develops as a complication of either gastrointestinal or urogenital infection or surgical procedures. It can present with mild symptoms or life-threatening peritonitis. Imaging studies help to diagnose the condition while microbiological studies are required to identify the causative organism.
Presentation
A pelvic abscess represents the penultimate stage of a pelvic cavity infection [1]. It can occur spontaneously in Crohn's disease [2] but is usually secondary to infections and surgeries in the abdominopelvic region. Acute diverticulitis with perforation of the colon has been reported to be the commonest cause of pelvic abscess [3] while other causes are a pelvic inflammatory disease (PID), obstetric/ prostate/ colon surgeries, Crohn's disease and appendicitis. Risk factors for pelvic abscess include diabetes mellitus, immunodeficiencies, malignancies, and pregnancies.
Although immunosuppressed patients and the elderly present few or no symptoms [4], most patients present with constitutional symptoms of anorexia, high-grade fever, asthenia, nausea, and vomiting. Irritation of the peritoneum or neighboring organs can cause bilateral lower quadrant abdominal pain, diarrhea, prostration, increased frequency of urination, dysuria, foul-smelling vaginal discharge, vaginal bleeding, and dyspareunia. Non-specific flank pain or limp may be the initial presentation in cases with involvement of the psoas muscle by a pelvic abscess [5].
If the abscess ruptures, then clinical features of peritonitis such as severe abdominal guarding and rigidity are noted. Fistulous tracts leading from the abscess cavity into the affected part of the intestine [6] occur in patients with Crohn's disease and this is associated with severe abdominal pain and a palpable swelling [7]. One-third of these patients also have rebound tenderness [8].
Unless diagnosed and treated emergently, a ruptured pelvic abscess with peritonitis can be life-threatening.
Entire Body System
- Fever
Physicians should consider a diagnosis of tuboovarian abscess in a patient reporting fever and pelvic pain after IVF and embryo transfer. Published by Elsevier Inc. [ncbi.nlm.nih.gov]
She has had a persistent fever of 39.4 (103) despite three days of appropriate antibiotics covering both aerobes and anaerobes. She had normal lochial flow. [medbullets.com]
If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill. [webmd.com]
PHYSICAL FINDINGS & CLINICAL PRESENTATION • Abdominal or pelvic pain (90%) • Fever or chills (50%) • Abnormal bleeding (21%) • Vaginal discharge (28%) • Nausea (26%) • Up to 60% to 80% present in the absence of fever or leukocytosis; lack of these findings [encyclopedia.lubopitko-bg.com]
- Weakness
The EMG should be done after at least 3 weeks after the surgery/onset of the weakness. What kind of improvement if any have you noticed since then? I'm very much interested in learning about your case and the results of your EMG. [healthquestions.medhelp.org]
You may have: Swollen belly Diarrhea Fever or chills Lack of appetite and possible weight loss Nausea or vomiting Weakness Cough Your symptoms can be a sign of many different problems. [medlineplus.gov]
Some common causes of abdominal abscesses are listed below: Bowel perforation- often due to an underlying disease process or weakness. This includes peptic ulcer perforation. [myvmc.com]
Clostridium sordellii -Associated Toxic Shock Syndrome The TSS associated with C. sordellii is characterized by the sudden onset of weakness, nausea, and vomiting followed by progressive refractory hypotension associated with local and spreading edema [glowm.com]
- Fatigue
Other symptoms may also arise, including fever, nausea, fatigue, vomiting, difficulty passing a stool, pus in the stools and a high temperature. Such symptoms should prompt medical practitioners to suspect an infection. [glynns.co.uk]
- Intravenous Administration
Eight days after admission, the IUD was removed, while intravenous administration of ampicillin (4 g/day) was initiated. Her recovery was quite good; WBC count and CRP returned to normal levels in a week by antibiotic treatment. [jmedicalcasereports.biomedcentral.com]
Gastrointestinal
- Abdominal Pain
Fistulous tracts leading from the abscess cavity into the affected part of the intestine occur in patients with Crohn's disease and this is associated with severe abdominal pain and a palpable swelling. [symptoma.com]
We present an unusual occurrence in which office Pipelle endometrial sampling in a perimenopausal patient was complicated 10 days later by lower abdominal pain and intermittent fever. [ncbi.nlm.nih.gov]
In light of worsening and shifting abdominal pain, the diagnosis of appendicitis was reconsidered and exploratory laparotomy recommended. [meddean.luc.edu]
- Vomiting
You may have: Swollen belly Diarrhea Fever or chills Lack of appetite and possible weight loss Nausea or vomiting Weakness Cough Your symptoms can be a sign of many different problems. [medlineplus.gov]
Although immunosuppressed patients and the elderly present few or no symptoms, most patients present with constitutional symptoms of anorexia, high-grade fever, asthenia, nausea, and vomiting. [symptoma.com]
She presented to our emergency room four days later with sudden onset of diaphoresis, nausea, vomiting, and loose stools. [meddean.luc.edu]
Systemic Symptoms Include: Fever Body malaise Nausea Vomiting Anorexia Localized Symptoms: Abdominal pain Abdominal tenderness Diarrhea Rectal mucous discharges Urinary frequency Dysuria Tender pelvic peritoneum upon pelvic examination. [simple-remedies.com]
Patients may also present with fever, nausea, vomiting and general malaise, but this is variable and may range from minimally symptomatic to toxic appearing. [saem.org]
- Nausea
You may have: Swollen belly Diarrhea Fever or chills Lack of appetite and possible weight loss Nausea or vomiting Weakness Cough Your symptoms can be a sign of many different problems. [medlineplus.gov]
Although immunosuppressed patients and the elderly present few or no symptoms, most patients present with constitutional symptoms of anorexia, high-grade fever, asthenia, nausea, and vomiting. [symptoma.com]
Other symptoms include nausea, loss of appetite, and weight loss. [merckmanuals.com]
Systemic Symptoms Include: Fever Body malaise Nausea Vomiting Anorexia Localized Symptoms: Abdominal pain Abdominal tenderness Diarrhea Rectal mucous discharges Urinary frequency Dysuria Tender pelvic peritoneum upon pelvic examination. [simple-remedies.com]
Other symptoms may also arise, including fever, nausea, fatigue, vomiting, difficulty passing a stool, pus in the stools and a high temperature. Such symptoms should prompt medical practitioners to suspect an infection. [glynns.co.uk]
- Pelvic Mass
We describe a patient in whom the diagnosis of a pelvic mass was made by sonography and MRI at 25 weeks' gestation. At laparotomy, a pelvic abscess was partially resected and drained. [ncbi.nlm.nih.gov]
Features are non-specific and may include: soft tissue density mass loss of normal pelvic fat planes an adynamic ileus may be present Ultrasound Transabdominal and endovaginal ultrasound are the preferred initial imaging investigations. [radiopaedia.org]
Laparotomy showed a double-lobed retrouterine pelvic mass of 10x7x5cm and solid-cystic appearance. It was attached to the pelvic walls, the posterior side of the uterus, the pouch of Douglas, and the anterior surface of the sigmoid rectum. [revistas.unal.edu.co]
The clinical diagnosis is generally based on the findings of fever and a palpable adnexal or pelvic mass. This mass may be distinctly palpable and fluctuant or less distinct and characterized by a “fullness” noted during bimanual pelvic examination. [glowm.com]
- Abdominal Tenderness
Systemic Symptoms Include: Fever Body malaise Nausea Vomiting Anorexia Localized Symptoms: Abdominal pain Abdominal tenderness Diarrhea Rectal mucous discharges Urinary frequency Dysuria Tender pelvic peritoneum upon pelvic examination. [simple-remedies.com]
The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present. [saem.org]
Physical exam findings in PID often include the following: a temperature greater than 101 F (38.3 C); abnormal vaginal discharge ; lower abdominal tenderness when exterior pressure is applied; tenderness when the cervix is moved (during a bimanual or [emedicinehealth.com]
Physical examination revealed diffuse abdominal tenderness. Clinical considerations included duodenal hematoma and appendicitis. [meddean.luc.edu]
Cardiovascular
- Tachycardia
Pelvic and abdominal pain which is bilateral and aggravated by motion and intercourse, and fever possibly exceeding 103 degrees fahrenheit with leucocytosis, tachycardia, and prostration are the most common symptoms of pelvic abscess. [ncbi.nlm.nih.gov]
Alternatives: ampicillin sulbactam 3 g IV q6h or cefoxitin 2 g IV q6h or cefotetan 2 g IV q12h plus doxycyline 100 mg IV q12h • During medical management, high index of suspicion for acute rupture, such as acute worsening of abdominal pain or new-onset tachycardia [encyclopedia.lubopitko-bg.com]
With generalised peritonitis, the patient is very unwell, with marked fever, tachycardia and dehydration. There is diffuse abdominal pain, exacerbated by even the slightest movement. [surgwiki.com]
Her vital signs revealed a temperature of 38.1°C with resting tachycardia, stable blood pressure and respiratory rate. Pertinent physical exam findings included normal breast andlower limbs. [ommegaonline.org]
Although tachycardia is common with fever and a pulse of greater than 90 beats/min qualifies as one of the criteria for sepsis. [glowm.com]
Skin
- Flushing
The catheters were flushed periodically until resolution of the abscess was confirmed by CT imaging. MAIN OUTCOME MEASUREMENTS: Resolution of a pelvic abscess on follow-up CT and improvement in clinical symptoms. [ncbi.nlm.nih.gov]
This may include soaking or flushing. Be sure to keep all follow-up appointments. Report any fever, redness, swelling, or increased pain to your doctor immediately. [webmd.com]
Musculoskeletal
- Low Back Pain
Nonspecific symptoms such as low back pain and fever delayed diagnosis, which may have led to secondary fractures. [ncbi.nlm.nih.gov]
back pain accompanied by fever and leukocytosis. [radiopaedia.org]
- Hip Pain
Fever and hip pain developed abruptly 1 week later when she was ready for discharge from hospital. Magnetic resonance imaging (MRI) of the pelvis disclosed an intramuscular abscess. [ncbi.nlm.nih.gov]
Psychiatrical
- Withdrawn
Twenty-nine days after the placement, the catheter was withdrawn safely and the abscess cavity had shrunk remarkably. [ncbi.nlm.nih.gov]
Neurologic
- Irritability
Irritation of the peritoneum or neighboring organs can cause bilateral lower quadrant abdominal pain, diarrhea, prostration, increased frequency of urination, dysuria, foul-smelling vaginal discharge, vaginal bleeding, and dyspareunia. [symptoma.com]
Symptoms may include abdominal pain, diarrhea caused by intestinal irritation, and an urgent or frequent need to urinate caused by bladder irritation. [merckmanuals.com]
It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis. [healthquestions.medhelp.org]
On physical examination, a palpable mass can be found in only 55% of cases; signs of peritoneal irritation are not common (6). [revistas.unal.edu.co]
- Asthenia
Although immunosuppressed patients and the elderly present few or no symptoms, most patients present with constitutional symptoms of anorexia, high-grade fever, asthenia, nausea, and vomiting. [symptoma.com]
An 88-year old male patient presented with severe anaemia, asthenia and melaena in the previous days. [giornalechirurgia.it]
Urogenital
- Pelvic Pain
RESULT(S): The CT scan revealed several large, multiloculated pelvic and tuboovarian abscesses. The patient defervesced after 6 days of intravenous antibiotics, but the pelvic pain did not improve. [ncbi.nlm.nih.gov]
Determine which women with PID require hospitalization Initial Actions and Primary Survey When a woman of reproductive age presents with vaginal discharge or pelvic pain, a pelvic exam and pregnancy test should always be performed. [saem.org]
pain in a female, and PID may be found incidentally. [emedicine.medscape.com]
This can even develop to ectopic pregnancy or chronic pelvic pain and even death. Preventing the attack of the disease is very important for female health. [home-remedies-for-you.com]
- Salpingitis
N70.0 Acute salpingitis and oophoritis N70.1 Chronic salpingitis and oophoritis Hydrosalpinx N70.9 Salpingitis and oophoritis, unspecified N71 Inflammatory disease of uterus, except cervix Includes: endo(myo)metritis metritis myometritis pyometra uterine [apps.who.int]
The impression was of rare pelvic inflammatory disease in pregnancy, which developed into right tubo-ovarian abscess with acute salpingitis post partum. [casereports.bmj.com]
Salpingitis was considered mild PID, whereas pyosalpinx and TOA were considered severe PID. [laparoscopyhospital.com]
[…] pel·vic ab·scess an abscess in the pelvic peritoneal cavity, developing as a complication of diffuse peritonitis or of localized peritonitis associated with abdominal or pelvic inflammatory disease, such as salpingitis; the pus frequently collects in [medical-dictionary.thefreedictionary.com]
[…] is the long-term sequelae of chronic pelvic pain, infertility, and ectopic pregnancy due to scarring and adhesions that burden the healthcare system in an adverse manner. [3, 4, 5] It encompasses a broad category of diseases, including endometritis, salpingitis [emedicine.medscape.com]
- Adnexal Mass
Contrasted magnetic resonance imaging (MRI) was requested, finding right adnexal mass compatible with simple cyst and left adnexal mass with solid and cystic component of 152x120x103mm; the solid zone had low signal on T2, without enhancement or restriction [revistas.unal.edu.co]
Findings may include: multilocular complex retro-uterine/adnexal mass debris, septations, and irregular thick walls commonly bilateral echogenic debris within the pelvis CT Can be a helpful adjunct to ultrasound especially in determining the extent of [radiopaedia.org]
or suspicion of rupture) • Poor response to medical therapy in those with adnexal masses >8 cm, bilateral disease, or immunocompromise • Antibiotic combinations: 1. [encyclopedia.lubopitko-bg.com]
A palpable adnexal mass may be seen in complicated PID with TOA. [emedicine.medscape.com]
Bimanual examination revealed no adnexal mass or tenderness, no cervical excitation. Larger amounts of pussy fluid exuded from the vagina. [ommegaonline.org]
- Dyspareunia
Irritation of the peritoneum or neighboring organs can cause bilateral lower quadrant abdominal pain, diarrhea, prostration, increased frequency of urination, dysuria, foul-smelling vaginal discharge, vaginal bleeding, and dyspareunia. [symptoma.com]
The complications of PID include chronic pelvic pain, dyspareunia, infertility, ectopic pregnancy, TOA and Fitz-Hugh-Curtis syndrome. Women with a previous episode of PID are 12-15 % more likely to have an ectopic pregnancy. [saem.org]
The patient did report dyspareunia at the 1-year follow-up. Fig. 1 From patient #3. A sagittal midline image from the initial oral and intravenous contrast-enhanced CT. [link.springer.com]
- Urinary Incontinence
Manufacturers have adamant about changing the mesh composition rather than finding a more natural and less toxic remedy for SUI (stress urinary incontinence) and POP (pelvic organ prolapse). [pelvicmeshownersguide.com]
Workup
Clinical suspicion, a thorough history, along with pelvic and rectal examination help to recognize pelvic abscesses in a majority of the patients [4]. Bimanual palpation may elicit tenderness in either the cul-de-sac or adnexal region in pelvic abscess secondary to PID.
Routine laboratory tests such as a complete blood count and inflammatory markers may reveal leukocytosis and elevated erythrocyte sedimentation rate. Serological tests for autoimmune conditions, syphilis, and human immunodeficiency virus are performed based on clinical findings. A cervical swab is required to identify chlamydial or gonorrheal infection while urinalysis may detect pus cells.
The gold standard test for diagnosing a pelvic abscess is an abdominopelvic ultrasonogram which (US) is performed initially as it can differentiate between an abscess and appendicitis while a transvaginal ultrasound, in cases with PID, helps to confirm and localize the abscess.
Computed tomography (CT) with contrast or magnetic resonance imaging (MRI) are indicated in post-operative patients or patients with Crohn's disease or malignancies suspected to have enteric fistulae. CT with contrast (enterography) provides information regarding the severity of bowel inflammation and a concomitant fistula [9].
Imaging may show a thickened abscess wall in a chronic abscess [10] or an ill-defined border in case of a mass or a phlegmon [11]. US guided or CT guided aspiration of the purulent material from the pelvic abscess should be sent for microbiological staining, culture, and antibiotic sensitivity testing in all cases.
X-Ray
- X-Ray Abnormal
Abscesses near the diaphragm may result in chest x-ray abnormalities such as ipsilateral pleural effusion, elevated or immobile hemidiaphragm, lower lobe infiltrates, and atelectasis. CBC and blood cultures should be done. [msdmanuals.com]
Ultrasound
- Ovarian Mass
Additionally, bilateral complex masses are present; this finding is compatible with tubo-ovarian masses. [emedicine.medscape.com]
Combining a second generation multivariate index assay with ovarian imaging improves the preoperative assessment of an adnexal mass. [revistas.unal.edu.co]
Serum
- Neutrophilia
Acute abdominal symptoms, radiological finding of small bowel PI with massive PMVG, severe neutrophilia, and high serum lactate forced us to perform exploratory laparotomy, from which it was observed a diffuse band-like pneumatosis of all the small bowel [giornalechirurgia.it]
In the present case, TOA explains the leukocytosis with neutrophilia presented by the patient, as well as the unquantified fever, since no persistent or recurrent urinary tract infection was demonstrated. [revistas.unal.edu.co]
Laboratory
- Leukocytosis
[…] pelvic inflammatory disease ( tubo-ovarian abscess ) iatrogenic e.g. post surgical inflammatory bowel disease pelvic actinomycosis infection diverticulitis Presenting complaints are varied and include pelvic or low back pain accompanied by fever and leukocytosis [radiopaedia.org]
The patient had pyuria, suprapubic pain and leukocytosis at that time. Radiopharmaceutical: .459 mCi In-111 labeled autologous leukocytes i.v. [gamma.wustl.edu]
In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. [ncbi.nlm.nih.gov]
PHYSICAL FINDINGS & CLINICAL PRESENTATION • Abdominal or pelvic pain (90%) • Fever or chills (50%) • Abnormal bleeding (21%) • Vaginal discharge (28%) • Nausea (26%) • Up to 60% to 80% present in the absence of fever or leukocytosis; lack of these findings [encyclopedia.lubopitko-bg.com]
The patient was febrile, and a complete blood count revealed leukocytosis. CT, shown below, was requested to evaluate for appendicitis. Figure 1. [meddean.luc.edu]
Treatment
Given the morbidity and mortality associated with these infections, aggressive treatment with amphotericin B and drainage of abscesses is warranted. [ncbi.nlm.nih.gov]
Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery. 1. [file.scirp.org]
Prognosis
Prognosis of pelvic inflammatory disease The prognosis of PID depends mostly on the awareness of adolescents to look for timely health care and to prevent future episodes of sexually-transmitted infections. [news-medical.net]
Treatment and prognosis Percutaneous abscess drainage which is the standard treatment for abdominal and pelvic abscesses in the absence of an acute surgical abdomen. Broad-spectrum antibiotic therapy is given concurrently. [radiopaedia.org]
Prognosis The prognosis will depend on the aetiology of the abscess, underlying well-being of the patient and the speed of diagnosis and effective management. An abscess may sometimes drain spontaneously into the rectum. [patient.info]
Definitive diagnosis is important for prompt treatment and improved prognosis. Medical diagnoses that need to be ruled out include pelvic inflammatory disease, appendicitis, diverticulitis, generalized peritonitis, and septic abortion. [simple-remedies.com]
Gastrointestinal stromal tumors: Review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006;130:1466-78. 8. Sandrasegaran K, Rajesh A, Rydberg J, Rushing DA, Akisik FM, Henley JD. [mjmsr.net]
Etiology
There are four categories based on etiologic factors: • Ascending infection, spreading from cervix through endometrial cavity to adnexa, forming a tuboovarian complex • Infection occurring in the puerperium, which spreads to the adnexa from the endometrium [encyclopedia.lubopitko-bg.com]
After completion of this article, the reader will be able to understand the nonsurgical alternatives for the drainage of intraabdominal abscesses, the possible etiologies of intraabdominal abscess formation in the pregnant population, and the various [ncbi.nlm.nih.gov]
Etiology Some of the causes include: pelvic inflammatory disease ( tubo-ovarian abscess ) iatrogenic e.g. post surgical inflammatory bowel disease pelvic actinomycosis infection diverticulitis Presenting complaints are varied and include pelvic or low [radiopaedia.org]
Epidemiology
It is hoped that with a better understanding of the epidemiology of PID and with the advent of improved diagnostic and therapeutic modalities for early genital tract infection, a pelvic abscess will eventually become a great rarity on gynecology services [ncbi.nlm.nih.gov]
[…] via hematogenous or lymphatic route • Abscess complicating pelvic surgery • Involvement of the pelvic viscera secondary to spread from contiguous organs, such as appendicitis or diverticulitis SYNONYMS Tuboovarian abscess (TOA) Vaginal cuff abscess EPIDEMIOLOGY [encyclopedia.lubopitko-bg.com]
In this case it is an inflammatory mass which involves the ovary and Fallopian tube. [ 1, 2 ] Epidemiology Uncommon. Predisposing factors include Crohn's disease, diabetes mellitus, immunodeficiency and pregnancy. [patient.info]
Direct extension of infection from adjacent viscera and uterine instrumentation are more important risk factors in postmenopausal PID. [32] Epidemiology Annually, approximately 1 million women develop PID. [1] PID is most commonly seen in young women [emedicine.medscape.com]
Retrieved February 21, 2015. ^ a b "Self-Study STD Modules for Clinicians — Pelvic Inflammatory Disease (PID) Next Centers for Disease Control and Prevention Your Online Source for Credible Health Information CDC Home Footer Separator Rectangle Epidemiology [en.wikipedia.org]
Pathophysiology
Carolina O Nastri (2010) ovarian hyper stimulation syndrome: pathophysiology and prevention. [omicsgroup.org]
Associated pathophysiologic effects may become life threatening or lead to extended periods of morbidity with prolonged hospitalization. [emedicine.medscape.com]
Return to Pathophysiology Return to Atypical Clinical Presentation (C) Return to Primary Treatment Return to CT Findings Case 8 Perforated appendicitis with generalized peritonitis and multiple abscesses. 14 year old girl presented with one week history [meddean.luc.edu]
The pathophysiology of SPT is outlined by Virchow's triad: Venous stasis Injury to the vascular epithelium A hypercoagulable state These factors explain why SPT is almost always a puerperal event that is most commonly diagnosed after postcesarean endomyometritis [glowm.com]
Prevention
Surgical removal to prevent such complications can be considered, balanced against the high operative risks. [ncbi.nlm.nih.gov]
Aggressive antibiotic therapy to treat peritonitis or to prevent it from occurring. [simple-remedies.com]
Preventing the attack of the disease is very important for female health. Very simple and acceptable precautions can help control bacterial transmission while sexual intercourse. [home-remedies-for-you.com]
References
- Benigno BB. Medical and surgical management of the pelvic abscess. Clini Obstet Gynecol. 1981 Dec;24(4): 1187-97
- Richards RJ. Management of abdominal and pelvic abscess in Crohn's disease. World J Gastrointest Endosc. 2011 Nov 16; 3(11):209-12.
- Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K. Prognostic factors for survival in colonic perforation. Int J Colorectal Dis. 1994;9:158–162.
- Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 2010;11:79–109.
- Dala-Ali BM, Lloyd MA, Janipireddy SB, Atkinson HD. A case report of a septic hip secondary to a psoas abscess. J Orthop Surg Res. 2010;5:70.
- Fleshman JW. Pyogenic complications of Crohn's disease, evaluation, and management. J Gastrointest Surg. 2008;12:2160–2163.
- Georgopoulos F, Mylonaki M, Malgarinos G, et al. Intraabdominal abscesses in patients with Crohn’s disease: Clinical data and therapeutic manipulations in 17 cases of a single hospital setting. Annals of Gastroenterology. 2008;21:188–192.
- Gutierrez A, Lee H, Sands BE. Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn's disease. Am J Gastroenterol. 2006;101:2283–2289.
- Macari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol. 2007;188:1344–1355
- Clayton J. Radiologic considerations in pelvic and intra-abdominal infections. In Pastorek JG III (ed): Obstetric and Gynecologic Infectious Disease. New York, Raven Press, 1994.
- Kim HC, Yang DM, Lee CM, et al. Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol. 2011 Dec; 84(1008):1115-20.