Persistent intra-abdominal abscess with intestinal obstruction following seven failed drainage procedures over 3.5 years: a case report

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BACKGROUND: Intra-abdominal abscesses are common post-operative complications, typically resolving with percutaneous drainage and antibiotics. Chronic, refractory abscesses persisting for years and progressing to mechanical bowel obstruction are exceedingly rare. CASE PRESENTATION: We report a 36-year-old female who developed a persistent intra-abdominal abscess following an ovarian cystectomy, with symptoms persisting for 3½ years despite seven drainage procedures and two exploratory laparotomies. She presented with progressive abdominal distension, vomiting, and signs of bowel obstruction. Imaging confirmed a chronic organized abscess abutting bowel loops. Definitive management included bowel and omental resection with restoration of bowel continuity. Histopathology revealed chronic suppurative inflammation without granulomas or malignancy. CONCLUSION: This case highlights the need to consider chronic intra-abdominal abscess in the differential diagnosis of persistent post-operative symptoms and underscores the importance of timely surgical intervention in refractory cases to prevent progression to rare complications such as mechanical bowel obstruction.

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