PMC3872157_01
Abdominal wall transabdominal ultrasonography in longitudinal plane with linear probe in trapezoid format showed a mixed echogenicity, oval-shaped space occupying lesion with smooth borders which is situated in the abdominal wall of the left lower quadrant of the abdomen. The echogenic foci situated within the mass possibly represented debris.
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The ultrasonography of the left lower quadrant of the abdominal wall demonstrated a relatively well-demarcated, oval-shaped mass with mixed echogenicity (relatively more hyperechogenic) whose dimensions were 6.5 x 2.12 cm (Figure 1).
Axial images of contrast-enhanced abdominal MDCT showed wall thickening with narrowing of the lumen and multiple diverticula of the sigmoid colon. There is also pericolic fat stranding, an umbilical hernia (a), thickening of the abdominal wall ((a), (b)), and extraluminal air collection (b). In image (c), we see a bilocular abscess in the lower left abdominal wall and the communication between the abscess and the intra-abdominal inflammation.
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There was also a hiatal hernia containing the stomach and an umbilical hernia (Figures 2, 3, and 4).
Coronal (a) and sagittal (b) MPR images make more evident the presence of the abscess cavity and its relationship to the abdominal wall, the fat stranding, and the presence of extraluminal free air collection. In image (b), we notice the communication between the abscess and the intraperitoneal inflammatory process.
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There was also a hiatal hernia containing the stomach and an umbilical hernia (Figures 2, 3, and 4).
3D volume rendering technique imaging demonstrates the unilateral abdominal wall thickening which is caused by the abscess in relation to other adjacent anatomical structures (a). Image (b) was reconstructed in order to depict the extraluminal air collection in region of the sigmoid colon, in continuity with the abdominal wall abscess.
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There was also a hiatal hernia containing the stomach and an umbilical hernia (Figures 2, 3, and 4).
Photograph of the abdominal wall abscess after surgical drainage.
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Right after the abdominal MDCT, pus was drained from the abscess (Figure 5).
Contrast enhanced abdomen MDCT after surgical drainage of the abscess shows regression of the pericolic inflammation (a), decrease of the quantity of extraluminal air (a), and almost complete regression of the abdominal wall abscess (b). We can also notice the site of drainage in the subcutaneous fat tissue.
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During the next days, the patient reported alleviation of symptoms and the second MDCT obtained after the drainage showed regression of the inflammation, decrease of the quantity of extraluminal air, and almost complete regression of the abscess (Figure 6).