What is Subphrenic Abscess?
Subphrenic abscess is a medical condition where there is accumulation of pus or infected fluid in the space between the diaphragm, the spleen and the liver. Subphrenic abscess develops after surgical operations on abdomen such as splenectomy or bowel perforation. In subphrenic abscess, about half of the patients develop this condition on the right side, a quarter of patients develop it on the left side, and the remaining quarter of patients can experience subphrenic abscess simultaneously on both the sides.
As mentioned above, collection or accumulation of pus in the space located between the diaphragm and the transverse colon is known as subphrenic abscess. This condition develops usually about 3 to 6 weeks after any abdominal surgery, such as appendix surgery or any surgery in the duodenum or the stomach. Subphrenic abscess tends to develop more in elderly patients.
Treatment for Subphrenic Abscess comprises of draining the abscess and treating the infection with antibiotics.
Causes of Subphrenic Abscess
Patient develops subphrenic abscess after any surgery on the abdomen. The pus accumulates under the patient's diaphragm, which usually spreads from some other location in the abdomen.
A subphrenic abscess can occur secondary to the following conditions:
- Peritonitis, which can be either general or local, which occurs after a perforated peptic or typhoid ulcer.
- Subphrenic abscess can be caused due to appendicitis.
- Infection following a caesarean section can cause subphrenic abscess.
- Pelvic Inflammatory Disease (PID).
- A laparotomy procedure during which there was contamination of the peritoneal cavity can cause subphrenic abscess.
- Any injury or trauma which has ruptured a hollow organ and contaminated the peritoneal cavity leading to formation of subphrenic abscess.
- Rupture of amoebic liver abscess.
Signs & Symptoms of Subphrenic Abscess
A combination of signs and symptoms of subphrenic abscess can be present including:
- Patient has fever and chills.
- Patient has cough with shallow respiration and increased respiratory rate.
- There are diminished or absent breath sounds.
- Patient may have hiccups.
- Dullness is felt upon percussion.
- There is tenderness over the area of 8th to 11th ribs.
- Patient suffering from subphrenic abscess can also experience pain on the shoulder tip on the affected side.
- Patient suffering from subphrenic abscess also experiences appetite loss about one month after any surgery on the abdomen.
- Patient may have a non-productive cough.
- One of the symptoms of subphrenic abscess is pain is felt in the abdomen on the affected side where the pus has collected.
- Upon doing blood tests, it is found that the patient has leukocytosis and decreased red blood cells, which leads to anemia in the patient.
- Upon doing x-ray, an abscess cavity filled with gas is seen and abnormalities of the lung also appear on the abdominal X-ray.
Diagnosis of Subphrenic Abscess
- Medical history and physical examination.
- CT scan.
- Blood tests.
Treatment for Subphrenic Abscess
- Treatment for Subphrenic Abscess is same as for abscess in any other part of the body.
- A subphrenic abscess also needs to be drained. After which antibiotics are used to treat the infection.
- Drainage of the subphrenic abscess is a complex task and can be done either through surgery or by using a drainage catheter.
- It is important to monitor the patient's nutritional status as patients with subphrenic abscess are usually malnourished.
- Painkillers, such as paracetamol or ibuprofen can be prescribed to control the pain associated with subphrenic abscess.
- Other complications can also occur, such as clots in the veins of the leg or in the portal system veins. Treatment for this is done with Coumadin and heparin.
- If this condition is not diagnosed properly or if there is any delay in the treatment, then patient could suffer from sepsis, go into septic shock and can ultimately die.
- The prognosis of subphrenic abscess is good if the condition is diagnosed correctly and treatment is started immediately. According to research, subphrenic abscess carries a mortality rate of about 35% even with the best treatment.