Complications of subphrenic abscess. Their incidence with special reference to abscess therapy.
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Even today subphrenic abscesses constitute a major problem for the surgeons who are at times their involuntary cause. These abscesses are characterised by a high mortality rate and difficulty of treatment. A careful review of the literature and a fortunately modest experience form the basis for an assessment of what has been achieved and what problems still remain with particular reference to new diagnostic and therapeutic techniques.
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The combination of subphrenic abscess with purulent pericarditis is a rare postoperative complication of perforated appendicitis in children, with severe clinical course, difficult to diagnose and high case fatality rate. A 7-year-old child with this complication, successfully diagnosed and treated is reported. The importance of complex therapy--surgical and intensive and collaboration between pediatric surgeons, anesthesiologists, cardiac surgeons and cardiologists for the favourable outcome is emphasized.
Since the therapeutic management of an empyema is significantly different from that for a subphrenic abscess it is important to define the location of the diaphragm in relation to an abscess cavity. A patient is presented who underwent unnecessary laparotomy due to misinterpretation of the clinical and radiographic findings.
An unusual case of subphrenic abscess presenting as empyema of the pleural cavity is described. The abscess developed secondarily to an occult perforation of the gastrointestinal tract, which was, diagnosed indirectly by the discovery of a fishbone within the abscess. Isolation of Streptococcus milleri from the pus was an important clue for the existence of an underlying gastrointestinal pathology.
A 35 year-old male patient developed a subphrenic abscess in the immediate postoperative period after replacement of a calcified mitral bovine pericardium bioprosthesis. He was successfully treated with abdominal percutaneous drainage and antimicrobial therapy.
To assess the value of liver-lung scanning in the diagnosis of right subphrenic abscess, 148 scans were reviewed against corresponding charts. Of 91 scans with adequate clinical data, overall scanning error was 19.3% with 14 false positive and 3 false negative scans. Among 49 scans (of the initial group of 91 studies) with presence or absence of actual pathology proved by surgery and/or autopsy, there were 3 true positive, 12 false positive, 29 true negative, and 3 false negative scans. Analysis of data indicated (1) lower accuracy of scan interpretations than generally reported, (2) low specificity for positive scans and high specificity for negative scans, (3) correlations of false interpretations with atypical degrees of liver-lung separation and with scanning defects in liver and lung, and (4) failure of rereading significantly to improve accuracy of interpretation.
This paper is a study of the evolution of the management of subphrenic abscess from the earliest reports to the present day. Its purpose is to compare and contrast the attitudes and practices established during the earlier years with those of the present, in particular in relation to changes consequent on the introduction of antibiotics.
We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.
Meckel's diverticulum is known to present with myriad complications. However, its perforation followed by development of subphrenic abscess has not been reported in literature. We report this complication in an eleven-month-old child.
A patient presented with a pneumococcal lobar pneumonia and later developed a subphrenic abscess. Peritonitis and intra-abdominal abscess formation should be remembered as a rare cause of delayed recovery from lobar pneumonia.
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The Authors describe four cases of chronic fistulous subphrenic abscess in abdominal and thoracic regions, which have come to their observation during the period of time between 1972-1979. The various locations of these abscess are being described together with the possible processes of formation, taking in to account, also for what emerges from literature, the silent course of the illness and the non specific characteristics concerning their symptomatology. Chronicity is a relatively rare condition and involves dangerous and prolonged exposures to the disease, any time the diagnosis is delayed. In the cases reported the first clinical symptoms of the abscess took place during a period of the ranging from 8 months to 6 years and 10 months after an operation. So one must think immediately to the disease when, even a long time after an operation on bile ducts or on gastroenteric canal, non specific clinical symptoms appear even though the clinical and radiological findings keep on being negative.
Abscess formation during the course of acute brucellosis is a rare event. A case of subphrenic abscess, the first to our knowledge, is described. A 49 years-old male patient with fever and a mild increase in ALT and gamma-GT was referred to our Institution. Routine blood exams tested negative and antibodies against Brucella spp. Were also negative. CT examination of abdomen was normal. After 8 days, US examination showed a liquid area under the right diaphragma and US-guided puncture revealed an abscess; pus culture showed the presence of Brucella melitensis. Seven days later theWright reaction became positive. After percutaneous catheter drainage of the abscess, fever disappeared and US follow-up showed reconstitution of subphrenic space. Our study confirm that sonography is a valid method to demonstrate abdominal abscess and that US-guided percutaneous puncture and drainage are useful tools in diagnosis and treatment of fluid abdominal collections
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The natural biology of spilled intraperitoneal gallstones is not known. We report a patient with subphrenic abscess following spilled gallstones at laparoscopic cholecystectomy.
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