Subphrenic abscess

Pus accumulation in the space between the diaphragm and the transverse colon and its mesentery on one or both sides is commonly referred to as subphrenic abscess. Subphrenic abscess may occur in one or more than two spaces. It often secondary to complications of peritonitis such as visceral perforation and inflammation. When a patient develops a subphrenic abscess, timely treatment should be provided, and the treatment outcome is good. If fever and abdominal pain occur after acute peritonitis or inflammatory diseases of intra-abdominal organs have improved following treatment, or several days after abdominal surgery, this condition should be considered and further examinations should be performed. X-ray fluoroscopy may reveal elevation of the diaphragm on the affected side, with limited or absent movement during respiration, blurred costophrenic angle, and effusion. X-ray films may show pleural reaction, pleural effusion, partial atelectasis of the lower lung lobe, and an occupying shadow beneath the diaphragm. In left subphrenic abscess, the gastric fundus may be compressed and displaced downward; if the abscess contains gas, an air-fluid level may be present. Ultrasound or CT examination is of great help in the diagnosis and differential diagnosis of subphrenic abscess. In particular, diagnostic puncture guided by ultrasound can not only help with qualitative diagnosis, but also allow injection of antibiotics after aspiration for small abscesses. It should be noted that a negative puncture result cannot rule out the possibility of an abscess. Once a subphrenic abscess forms, obvious systemic and local symptoms may appear. Specific manifestations: 1. Systemic symptoms: fever, initially remittent fever, which becomes persistent high fever after abscess formation, or may be moderate persistent fever. Pulse rate increases, tongue coating is thick and greasy. Gradually, fatigue, weakness, night sweats, anorexia, weight loss, elevated white blood cell count, and increased neutrophil ratio appear; 2. Local symptoms: persistent dull pain may occur at the abscess site, worsening with deep breathing. The pain is often located near the midline below the costal margin or beneath the xiphoid process. If the abscess is located behind and below the liver, there may be renal area pain, sometimes radiating to the shoulder and neck. Irritation of the diaphragm by the abscess may cause hiccups. Subphrenic infection can spread through the lymphatic system to cause pleural and pulmonary reactions, resulting in pleural effusion, cough, and chest pain. If the abscess ruptures into the pleural cavity, empyema occurs. In recent years, due to the extensive use of antibiotics, local symptoms are often atypical. In severe cases, pitting edema of the local skin and increased skin temperature may occur. Breath sounds in the lower part of the affected side of the chest may be diminished or absent. Right subphrenic abscess may enlarge the liver dullness boundary. Approximately 10%-25% of abscess cavities contain gas.