Answer
Appropriate hematologic studies should be done. Hematologic parameters suggestive of infection (eg, leukocytosis, anemia, abnormal platelet counts, and abnormal liver function) frequently are present, although patients who are debilitated or elderly often fail to mount reactive leukocytosis or fever.
Blood cultures indicating persistent polymicrobial bacteremia strongly implicate the presence of an intra-abdominal abscess. Because more than 90% of intra-abdominal abscesses contain anaerobic organisms, particularly B fragilis, postoperative Bacteroides bacteremia suggests intra-abdominal sepsis.
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Media Gallery
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Percutaneous computed tomography (CT) scan–guided drainage of postoperative subhepatic collection.
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Contrast-enhanced computed tomography (CT) scan of infected pancreatic pseudocyst (which can develop from acute necrotizing pancreatitis and give rise to an abscess).
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A 35-year-old man with a history of Crohn disease presented with pain and swelling in the right abdomen. Figure A shows a thickened loop of terminal ileum adherent to the right anterior abdominal wall. In figure B, the right anterior abdominal wall, adjacent to the inflamed terminal ileum, is markedly thickened and edematous. Figure C shows a right lower quadrant abdominal wall abscess and enteric fistula (confirmed by the presence of enteral contrast in the abdominal wall).
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