IDIOPATHIC RIGHT SUB-PHRENIC ABSCESS CONTAINING GAS

Sub-Phrenic Abscess

Abstract

INTRODUCTION

The subphrenic space is arbitrarily defined as lying below the diaphragm and above the liver. About 55% of subphrenic abscesses are right-sided, 25% are left-sided, and 20% are multiple [1]. Most subphrenic abscesses arise from direct contamination after surgery, local disease, or injury. They develop from peritonitis secondary to another cause, such as a perforated viscus; extension from an abscess in an adjacent organ; or, most commonly, as a postoperative complication of abdominal surgery, especially on the biliary tract, duodenum, or stomach [2]. Nonproductive cough, chest pain, dyspnea, and shoulder pain may result from the effects of the infection on the adjacent diaphragm, and rales, rhonchi, or a friction rub may be audible. Dullness to percussion and decreased breath sounds are present when basilar atelectasis, pneumonia, or pleural effusion occurs [3]. The mortality rate of subphrenic abscesses is 25 to 40%; deaths occur from uncontrolled infection, malnutrition, and complications of prolonged hospitalization such as pulmonary emboli and nosocomial infections. Subdiaphragmatic abscesses may extend into the thoracic cavity, causing an empyema, a lung abscess, or pneumonia [4].