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July 2, 1982

Diagnosis of Intra-abdominal Abscess

JAMA. 1982;248(1):32. doi:10.1001/jama.1982.03330010016017

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To the Editor.—  I read the article by Joseph T. Ferrucci, Jr, MD, and Eric vanSonnenberg, MD (1981;246:2728), regarding radiological diagnosis and treatment of intra-abdominal abscesses. They reported 90% to 95% rates of true-abnormal and truenormal accuracy.I have treated a patient with hypertension and renal failure who had a weight loss of 45 kg and abdominal pain. A series of six upper gastrointestinal studies, three barium enema examinations, three computed tomographic scans, laparoscopy, and abdominal aortography all failed to yield a diagnosis. A third surgical opinion suggested laparotomy, and a 2-L abdominal abscess at the site of an intestinal perforation was found. The patient eventually died.The editorial comment of Charles B. Clayman, MD (1981;246:2727), reiterating that ultrasophisticated diagnostic methods should not unduly influence a clinical decision is affirmed. Although helpful and occasionally dramatic findings can be achieved with new techniques, clinical evaluation and determination are still necessary.