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[How to detect the hepatic origin of a subphrenic abscess].
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[Subphrenic abscess; ways of extraserous approach].
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[Case of conservatively treated subphrenic abscess].
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[Subphrenic abscess of the 1st Surgical Clinical of the University of Vienna in the last 24 years (1933-1957)].
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[Subphrenic abscess: an analysis of 24 cases].
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[Percutaneous drainage under echographic and x-ray control in suppurative cholecystitis and liver and subphrenic abscesses].
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[Diagnosis of subphrenic abscess by sonography (author's transl)].
The diagnosis of a subphrenic abscess by sonography is based mainly on the experience of the examiner. A short description of the normal subphrenium is given. The diagnostic criteria for a subphrenic abscess and the differentialdiagnosis are discussed. In 19 cases of subphrenic abscess in question the diagnosis was missed in two cases, giving a success rate of 89.5%.
[Subphrenic abscess due to ectopic appendicitis].
BACKGROUND: Idiopathic subphrenic abscesses are uncommon in children. Standard chest X-rays may provide the suspicion of this diagnosis. Initial percutaneous drainage of the collection is usually performed. Surgery is required when the underlying cause remains unknown. CASE REPORT: A 12-year-old boy presented signs of pulmonary abscess. Chest X-rays, ultrasonography and computed tomography established the diagnosis of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation. CONCLUSION: In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication.
Subphrenic abscess: a pulmonary presentation.
A patient with subphrenic abscess can present with pulmonary or abdominal symptoms because of the location of the abscess adjacent to the diaphragm. This thoracoabdominal clinical complex has been described previously and, if chest symptoms predominate, may obscure the diagnosis of subphrenic abscess. The case of a patient with occult abdominal pathology who presented with respiratory complaints is discussed.
Subphrenic abscess in children.
Nineteen consecutive cases of subphrenic abscess which were treated in the Royal Hospital for Sick Children, Glasgow, from 1962 to 1972 are analyzed. This complication of intra-abdominal suppuration of surgery still carries a grave prognosis. Four of the patients died (21 per cent); 2 deaths were related to the subphrenic abscess while the remaining 2 were not directly related to the abscess. The mean hospital stay of the survivors was 59 days (range 30-122 days). The changing patterns of aetiology and presentation which have recently been emphasized in general surgical practice are not reflected in this paediatric series.
[Diagnosis and treatment of subphrenic abscess].
The clinical picture of subphrenic abscess taking place against the background of the treatment with modern antibacterial drugs has changed essentially, which requires a complex solution of the problem of the timely abscess diagnosis. The antistaphylococcal plasma and gamma globulin applied together with other methods of intense therapy proved to be the most effective after the dissection of the abscess.
Eclectic drainage of subphrenic abscesses.
In 196 cases of subphrenic abscess from 1964 through 1979, 56% were attributable to gastric, hepatic, and colonic disease or surgery. Posttraumatic abscesses in younger patients became more frequent. Synchronous suprahepatic and subhepatic abscesses or bilateral abscesses accounted for 19%. Streptococci, Escherichia coli, Klebsiella, and Bacteroides species were the most frequently isolated organisms. Although the overall mortality rate was 40%, the surgical mortality rate decreased from 33% initially to 17% recently. The mortality rate of transperitoneal drainage decreased from 41% to 16%. From 1980 through early 1983, a success rate of 84%, with no fatalities, was achieved in percutaneous radiologic drainage of 25 unilocular abscesses. At present, radiologically guided drainage should be considered for unilocular abscesses and some bilocular ones. Although extraperitoneal, extrapleural surgical drainage remains an expeditious form of treatment, it may give way to radiologic drainage. Transperitoneal drainage is preferable for multifocal abscesses and for many abscesses secondary to complications of intraabdominal surgery.
[The role of computed tomography in assessing subphrenic abscesses after posttraumatic splenectomy].
INTRODUCTION: We studied subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with CT, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. We investigated the diagnostic accuracy of CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. MATERIAL AND METHODS: Thirteen patients with left subphrenic inflammatory abscesses after splenectomy for trauma were examined from 1994 to 1998. They were 9 men and 4 women ranging in age 16-67 years (mean: 32). CT demonstrated abscesses early postoperatively in 9 patients and late postoperatively (mean: 3 months) in 4 patients. Abscesses were diagnosed with CT on admission for an abdominal emergency in 3 cases; one abscess was found at outpatient US performed for persisting left abdominal pain. CT-guided percutaneous drainage was performed in all patients with the Trocar technique. RESULTS: A large inflammatory liquid collection with the typical "liquid pseudospleen" appearance and characterized by tomodensitometric coefficients of corpusculated fluid was seen in 3 cases. Multiple confluent lesions with septa were found in 3 cases. Contrastography of the abscess cavity with the injection of a water-soluble iodinated contrast agent was performed in 2 cases to detect fistulas connecting to the intestinal loops. Subphrenic abscesses had the same CT patterns both early and late postoperatively, with the collection organizing into thick and corpusculated phlogistic material and exhibiting enhanced capsulofibrous differentiation. Air bubbles and water-air levels within the collection were found in 7 cases and considered a pathognomonic sign of inflammatory abscesses. A periabscessual reaction involving intestinal loops and adjacent organs was seen in 4 cases. DISCUSSION AND CONCLUSIONS: Splenectomy causes depressed phagocytosis and decreases serum levels of IgM and antigen response. This calls for careful selection of the patients absolutely requiring splenectomy, such as those with decompensated circulation and multiple parenchymal ruptures or spleen detachment from its stalk. Subphrenic abscesses after splenectomy account for 2.5% of postoperative complications and those after splenectomy for trauma are rarer still, with 1.3%. CT is the imaging method of choice in detecting inflammatory abscesses in the residual splenic cavity and assessing their extent. CT-guided drainage is the first-line treatment, while surgery is reserved to later stages, when drainage fails or other complications occur. Finally, CT permits accurate positioning of the catheter inserted with the Trocar technique and its immediate monitoring, which permits to assess treatment efficacy.