Answer
Ultrasonography is readily available, portable, and inexpensive. The findings can be quite specific when correlated with the clinical picture. In experienced hands, ultrasonography has an accuracy rate greater than 90% for diagnosing intra-abdominal abscesses. Bedside ultrasonography is particularly useful for immobile, critically ill intensive care unit (ICU) patients.
A drawback of ultrasonography is that marked obesity, bowel gas, intervening viscera, surgical dressings, open wounds, and stomas can create problems with definition. In addition, the quality of the procedure is operator-dependent. These disadvantages may limit the efficacy of this modality in postoperative patients.
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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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