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Drainage of superficial and deep abscesses

  • An abscess is collection of pus within soft tissues
  • Occurs when hosts response to infection is inadequate
  • Predisposing factors include foreign bodies, haematoma formation and poor blood supply


  • An abscess contains bacteria, acute inflammatory cells, protein exudate and necrotic tissue
  • It is surrounded by granulation tissue (the 'pyogenic membrane')
  • The organisms usually involved are:
    • In superficial abscesses - Staph. aureus, Strep. pyogenes
    • In deep abscesses - Gram negative species (e.g. E. coli) and anaerobes (e.g. Bacteroides)

Clinical features

  • Superficial abscesses include infected sebaceous cysts, breast and pilonidal abscesses
  • Show cardinal features of inflammation - calor, rubor, dolor, tumor
    • Heat
    • Redness
    • Pain
    • Swelling
  • After a few days superficial abscess usually 'point' and are fluctuant
  • Deep abscesses include diverticular, subphrenic and anastomotic leaks
  • Patients shows signs of inflammation - swinging pyrexia, tachycardia, tachypnoea
  • Physical signs are otherwise difficult to demonstrate
  • Site of abscess may not be clinically apparent
  • Radiological imaging often required to make the diagnosis


  • All abscesses require adequate drainage
  • Should be performed under general anaesthesia
  • Antibiotics have little to offer as tissue penetration is usually poor
  • Prolonged antibiotic treatment can result in a chronic inflammatory mass (an 'antibioma')
  • Superficial abscesses are usually suitable for open drainage
  • For deep abscesses closed drainage may be attempted

Open technique

  • Superficial abscesses can usually be drained through a cruciate incision
  • Position of incision may allow depended drainage
  • Pus should be sent for microbiology
  • Loculi should be broken down and necrotic tissue excised
  • A dressing should be inserted into the wound
  • Packing is not required - it is painful

Closed techniques

  • Deep abscess can be treated by ultrasound or CT guided aspiration
  • Success can not always be guaranteed
  • Multiloculated abscesses may not drain adequately
  • Percutaneous access my be difficult because of the position of adjacent organs

CT appearance of an appendix abscess


Abraham N,  Doudle M,  Carson P.  Open versus closed treatment of abscesses. a controlled clinical trial.  Aust NZ J Surg 1997;  67:  173-176.



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