Subphrenic Abscess

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

“…THE clinical presentation and management of patients with subphrenic abscess continue to provide problems of considerable magnitude, with added difficulties in recent years owing to the masking effects of antibiotics (Halliday, 1975). A study of the clinical presentation of 104 patients treated at the Royal Prince Alfred Hospital, Sydney, between 1950and 1961(Halliday and Loewenthal, 1964 detailed aspects of these problems and discussed their significance. The aim of the present study is to record the patterns of presentation and treatment during 1962-73, and by a comparison of the two periods, to seek reasons for the continuing morbidity and mortality.…”

The Surgical Management of Subphrenic Abscess: A Historical Study

“…The principle of early recognition and observation until the abscess was ready for drainage became and remains a standard part of practice, but judgement of timing has now become more difficult. It is difficult to establish how much delay influences the prognosis (Harley, 1955: p, 92), but salutory experiences (Gerwig and Blades, 1955 ;Halliday and Loewenthal, 1964;Rosenberg, 1969) inevitably colour judgement. All clinicians recognize the debilitating effects of a subphrenic abscess.…”

“…They included 55 patients treated conservatively with a mortality of 6 7 3 % , but there is no indication whether these patients were deliberately selected or not. In the series reported by Halliday and Loewenthal (1964)~ the masking effects of antibiotics on such standard characteristics of subphrenic abscess as pyrexia and leucocytosis were documented, and a small group of patients was distinguished in whom elective conservative treatment was successful, though the potential for disaster was also emphasized by several instances of sudden internal rupture. Sherman et alii (1969) again use a subtitle "A continuing hazard" because the employment of antibiotics had in no way lowered the mortality of trans-serous drainage, though the frequency of some secondary complications was reduced when antibiotics were used.…”

“…As difficulties related to antibiotics increased, surgeons began to employ exploratory laparo-1969). tomy and drainage in an increasing proportion of patients (Gerwig and Blades, 1955 ;Dineen and McSherry, 1962 ;Halliday and Loewenthal, 1964;Magilligan, 1968;Sherman et alii, 1969). Ariel and Kazarian (1971) specifically recommend that major left perihepatic subphrenic abscesses should be dealt with by laparotomy and drainage.…”

Subphrenic Space Infection—Reassessment

“…Many believe that the incidence of subdiaphragmatic infection has not decreased but that many instances of infection previously operated upon now resolve with antibiotic therapy.2'4 10 27 Others, on the contrary hold that although antibiotic agents have reduced the need for operation diagnosis has been made more obscure and surgical treatment has been delayed. 16,17,22,30 In some instances, delay has resulted in complications such as perforation of the diaphragm with disastrous consequences. Despite these controversies, we with Strode28 have been impressed with the fact that the surgical treatment of subphrenic infection has declined to the point that surgical house officers have little experience in treating this condition which has become a rarity.…”