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Subphrenic Abscess

Laura B. Bishop, MD Reviewed 05/2023
 


BASICS

  • A complicated infection below the diaphragm

  • Synonym(s): sub- or infradiaphragmatic abscess

DESCRIPTION

  • The subphrenic space is a peritoneal space on each side of the falciform ligament, directly b...

DIAGNOSIS

Early diagnosis reduces morbidity and mortality. 

HISTORY

  • Recent abdominal surgery

  • Constitutional symptoms: fever, chills, diaphoresis, malaise

  • Pain: chest, shoulder (referred pain—Kehr sign), a...

TREATMENT

  • Source control (percutaneous or surgical drainage of the abscess) and correction of any ongoing contamination (repair of leaking anastomosis or perforation); keep NPO until source identified...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Follow-up in 1-week postdischarge to check drain site, drain output quantity and clarity. Check drains weekly. 

Patient Monitoring

Monitor for local skin infection/...

REFERENCES

1
Mazuski  JE, Solomkin  JS. Intra-abdominal infections. Surg Clin North Am.  2009;89(2):421–437. [View Abstract on OvidMedline]
2
Morita S, Ka...

ADDITIONAL READING

Tyng CJ, Amoedo MK, Bohrer Y, et al. A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses. Cardiovasc Intervent Radiol. 2017;...

CODES

ICD10

  • K65.1 Peritoneal abscess

  • T81.4XXA Infection following a procedure, initial encounter

SNOMED

  • 52478002 subdiaphragmatic abscess (disorder)

  • 6212009 Postoperative subphrenic abscess (disorder)

CLINICAL PEARLS

  • Subphrenic abscesses are due to contamination of the sterile peritoneal cavity, most commonly with bacteria from the gastrointestinal tract.

  • Proper management involves determining the s...

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