Subphrenic abscess: A study of 241 patients at the Royal Prince Edward Hospital, 1950–73

Abstract

A series of 241 patients with subphrenic abscess was analysed to seek reasons for the continuing mortality. Aspects of pathology, clinical presentation, special investigations and management were affected by therapy with broad spectrum antibiotics to make diagnosis more difficult, particularly in relation to left subphrenic abscesses. When transperitoneal exploration and drainage were employed, high morbidity and mortality resulted. Satisfactory results followed extraserous drainage. The introduction of parenteral hyperalimentation promised control fistulas associated with abscesses, a situation hitherto associated with a poor prognosis.

Twelfth Rib Resection

“…Twenty-six consecutive patients underwent 27 twelfth rib resections (1 patient had bilateral rib resections) for the treatment of either a secondary subphrenic (23) or a subhepatic (4) abscess. There were 16 men, and the av¬ erage age for all patients was 40 years (range, 19-72 years).…”

Pseudo-splenomegaly as a result of subphrenic abscess

“…Over the past 25 years the proportion of subphrenic abscesses on the left has become predominant (Halliday & Halliday, 1976;Patterson, 1977). This fact has been related to the decline in numbers of patients with perforated appendices, and to an increasing number of operations being performed in the left upper quadrant (Patterson, 1977).…”

“…This fact has been related to the decline in numbers of patients with perforated appendices, and to an increasing number of operations being performed in the left upper quadrant (Patterson, 1977). Although the diagnosis of subphrenic abscess is most often made in the postoperative patient (Halliday & Halliday, 1976), secondary subphrenic abscesses do occur in other patients. The aetiological factors in Lerner's case (1970) remained speculative even though the patient had had a recent herniorrhaphy.…”

“…In Harley's series of subphrenic abscesses 1.6% occurred secondary to perforated gastric carcinoma (Harley, 1955b). Halliday & Halliday (1976) collected 241 subphrenic abscesses of which 15 (6.2%) followed perforation of a gastric carcinoma. Neither of these authors mention the presence of a palpable spleen in the presentation of these patients or in any of their patients with left-sided subphrenic abscesses.…”

“…It was felt that drainage of the abscess cavity was inadequate and after resuscitation urgent surgery was performed. At laparotomy a large carcinoma of the greater curve of the stomach was found which had perforated locally in the region of the spleen and tail of the pancreas resulting in a left perihepatic (Halliday & Halliday, 1976) subphrenic abscess. The spleen was confirmed to be ofnormal size (measuring 13 x 8 x 3 cm) and histology was normal.…”