Subphrenic Abscess
Definition: A subphrenic abscess is a collection of pus that forms in the subphrenic space, which is the area beneath the diaphragm.
Etiological Factors:
- Intra-abdominal infections
- Perforation of abdominal organs or viscera
- Postoperative complications
- Obstructive jaundice
- Neoplasm or abscess formation in the liver or spleen
Clinical Features:
- Fever
- Referred shoulder pain
- Restricted diaphragm movement
- Abdominal pain or tenderness
- Nausea and vomiting
- Decreased appetite
Investigations:
- Complete Blood Count (CBC)
- Inflammatory markers (e.g., C-reactive protein)
- Ultrasound
- Computed Tomography (CT)
- Chest X-ray
Imaging Findings:
- Ultrasound: collection of fluid in the subphrenic space
- CT: collection of fluid in the subphrenic space with or without gas or air-fluid levels
- X-ray: may show a pleural effusion or an air-fluid level in the subphrenic space
Indications for Surgical Drainage:
- Large abscesses
- Failed medical treatment
- Severe symptoms
- Presence of complications (e.g., peritonitis, sepsis)
Complications of Untreated Subphrenic Abscess:
- Peritonitis
- Sepsis
- Empyema
- Respiratory failure
- Death
Management and Treatment:
- Antibiotics
- Supportive care (e.g., hydration, nutrition)
- Surgical drainage (open or percutaneous)