Sub Phrenic Abcess

INTRODUCTION:
  • A pus-filled cavity in the subphrenic region which is the area below the diaphragm but above the colon and liver.
  • The infection can occur as a complication of abdominal surgery, acute pancreatitis and trauma. 
  • Subphrenic abscess is toxemia
  • The most common intraperitoneal abscess following peritonitis is Subphrenic abscess
SYMPTOMS:
  • Fever
  • Chills
  • Upper abdominal pain
  • Breathing difficulty
  • Painful breathing
  • Referred shoulder pain
  • Cough
DIAGNOSIS:
  1. X-RAYS are essential. Screening is the most important investigation and the cheapest. Look for:
  2. The failure of one side of his diaphragm to move.
  3. This is a sign of infection, but not necessarily of an abscess.
  4. Give him a little contrast medium, and look for downward and forward displacement of his stomach and spleen.
  • Also take a PA and a lateral view. Look for:
  1. Raised diaphragm, 
  2. Fuzzy upper border to his diaphragm
  3. Fluid in his costophrenic angle
  4. Collapse or consolidation at one lung base
  5. Fluid level (rare). 
  6. Gas in his subphrenic space. 
  7. This can be the residue from a laparotomy, or it can be due to a perforation of his gut, or to an anaerobic infection.
  • If his first X-ray examination is negative or equivocal, repeat it a few days later.
TREATMENT:
  • Surgical drainage of abscess and dead tissue removal
  • Chloramphenicol, metronidazole, gentamycin, tobramycin, amkiacin, clindamycin
Exam Question
  • Non-specific gas pattern in bowel and an air-fluid level in LUQ seen in Abdominal radiograph after Splenectomy is suggestive of Subphrenic abscess
  • Subphrenic abscess is toxemia
  • Complain of right hypochondrial pain with plain chest x ray showing elevated right hemidiaphragm is seen in Subphrenic abscess

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