The space between the diaphragm, which separates the chest cavities from the abdominal cavity, and the transverse colon is called the "subphrenic space". If there is an abscess developing in this space, this is called a subphrenic abscess. As there is a right and a left chest cavity, there can be from an anatomical point of view a right-sided and a left-sided subphrenic abscess.
In about 50% of the cases there is a right-sided, in 25% a left-sided and in 25% a bilateral subphrenic abscess. Typically this develops 3 to 6 weeks following surgery in the abdomen such as biliary surgery, appendix surgery or surgery on the stomach or duodenum.
Any anastomosis leakage or other wound contamination tends to lead to a subphrenic abscess. The pressures from the diaphragmatic movements with respirations are such that there is a movement of the ascitic fluid of the abdomen into the subphrenic space and with it travel any bacteria that might be present, which facilitates abscess formation.
Subphrenic abscesses are localized infection between the colon and the diaphragm on the left side of the diaphragm and the liver and the diaphragm on the right side of the abdomen. They may occur following rupture of any organ in the abdomen or following surgical procedures in the abdomen. 60% of the time the symptoms occur on the right, 25% on the left.. 15% of subphrenic abscesses occur on both side.
Symptoms of Subphrenic abscess
The list of signs and symptoms mentioned in various sources for Subphrenic abscess includes the 7 symptoms listed below:
Fever
Chills
Upper abdominal pain
Breathing difficulty
Painful breathing
Referred shoulder pain
Cough
Treatment
Like any other abscess in the body, the abscess needs to be drained and the infection needs to be treated with appropriate antibiotics. This can be a complex undertaking with a subphrenic abscess.
If there is an intraabdominal breakdown of an anastomosis, this has to be attended to by the surgeon as well as the abscess has to be drained. In another presentation it may be possible to drain the abscess through a percutaneous (meaning by perforating the skin) drainage catheter. Parallel to the clinical condition the physician needs to watch the patient's nutritional status as these patients often are malnourished and may need to receive intravenous feeding. If the nutritional status is not attended to the patients may not heal properly and cannot fight the infection with their weakened immune system.
Other complications can be clots in the leg veins or the portal system veins, which may have to be treated with heparin and Coumadin. The overall mortality rate is about 35% despite the best therapy.
Causes of Subphrenic Abscess
Blunt or penetrating trauma can lead to abdominal infections which eventually form a subphrenic abscess. Surgical procedures are a common cause. Infections, tumors or ulcers that lead to rupture of one of the abdominal organs can produce a subphrenic abscess.
Signs and Symptoms of Subphrenic Abscess
Fever and chills occur. There is pain in the upper abdomen, either on one side or both. There is difficulty breathing and pain with breathing. Due to irritation of the diaphragm there is shoulder pain.
Subphrenic abscess: 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. More detailed information about the symptoms, causes, and treatments of Subphrenic abscess is available below.
Subphrenic Abscess: Post-surgery Healthcare
Healthcare professionals monitor the patient while the drainage tube is in place and, when it is removed, a bag may be placed on the skin to collect any remaining pus. The wound will heal in less than a week, and it will take up to three months to return to normal health. Patients are advised to avoid heavy lifting after the subphrenic abscess procedure and Heparin and Coumadin are used to treat complications, such as, clots in the leg veins or the portal system veins. Minor aches and twinges on the wound may occur for up to six months.
Complications list for Sepsis
The list of complications that have been mentioned in various sources for Sepsis includes : -
Tissue destruction
Abscesses
Bacteremia
Septicemia
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In about 50% of the cases there is a right-sided, in 25% a left-sided and in 25% a bilateral subphrenic abscess. Typically this develops 3 to 6 weeks following surgery in the abdomen such as biliary surgery, appendix surgery or surgery on the stomach or duodenum.
