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Life sciences · Journal article
Cureus · October 10, 2026
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Abdominal wall abscesses (AWA) of primary etiology are rare, typically presenting in the context of atypical infections or in the setting of immunocompromise.Development of such pathology typically occurs only in the context of subclinical infections or severe systemic or metabolic disease.AWA more frequently develops as a secondary process due to underlying abdominal pathology such as chronic inflammatory conditions.In non-obese patients, AWA is often more readily apparent on exam with abnormalities of the abdominal contour, lending to prompt diagnosis and treatment, and even in those who are overweight, symptoms typically precede diagnosis as imaging is sought to delineate etiology.Herein, we present the case of an 82-year-old, morbidly obese man with a known history of atrial fibrillation who presented for three days of mild pain and drainage from a purported spider bite to the right lower quadrant of the abdomen, located along a distended pannus that had itself reportedly been present for 10 years.Initial examination showed firmness and swelling of the pannus and purulent drainage with minimal erythema surrounding a <1 cm lesion.Labs demonstrated leukocytosis with a WBC of 19.2 x 10 3 /μL and subsequent computed tomography (CT) of the abdomen and pelvis showed a complex fluid collection in the subcutaneous soft tissue of the abdominal wall, 36.5 x 11.1 x 18.3 cm, consistent with AWA.Infectious management was initiated with broad-spectrum antibiotics, and he was taken for incision and drainage (I&D) once medically stable, with intraoperative findings confirming the AWA with surrounding rind, which was excised with subsequent washout and wound vac placement.The patient's clinical course was further complicated by recurrence of atrial fibrillation with BPM in the 110-130s range and subsequent discovery of a 5 mm mitral valve vegetation on transesophageal echocardiogram.Wound cultures grew Bacteroides fragilis and Aeromonas hydrophila while blood cultures, in contrast, grew Streptococcus mitis.With treatment of both his AWA and newly discovered mitral valve endocarditis, the patient improved and was eventually discharged from the hospital following confirmation of persistently negative blood cultures.Primary AWA is a rare condition, and this report highlights a case which likely avoided detection for multiple years due to the patient's obese body habitus.The case strengthens the convention of treatment for primary AWA with combined surgical and antibiotic interventions and also highlights the need for extensive culture data to best characterize sources of infection in remote bodily sites.Overall, this helps to not only delineate treatment methods for a primary process, but to emphasize the importance of thorough, guided workup of an infectious process.