Subphrenic abscesses most commonly develop after surgery involving the duodenum, stomach, biliary tract, or appendix, or after rupture of a hollow viscus, such as a perforated peptic ulcer or acute appendicitis. Patients may present with fever and abdominal pain in the right or left upper quadrants. Other symptoms may include hiccups, jaundice, shoulder pain, chest pain, cough, dyspnea, or a pleural effusion.
The syndrome may be an acute, febrile illness, or a more chronic, insidious process with intermittent fevers, weight loss, and other constitutional symptoms. The chronic form develops most often in patients who have previously received antibiotics. The diagnosis of subphrenic abscess should always be considered in patients presenting with fever of unknown origin, especially if they have a history of abdominal surgery within the preceding few months.Computed tomographic scan and ultrasonography are the best methods for diagnosing a subphrenic abscess. An initial plain radiograph may give clues to the diagnosis, often showing a pleural effusion, an elevated hemidiaphragm, and concomitant lower lobe atelectasis or pneumonia.The primary treatment is drainage, via either a percutaneous procedure or an open laparotomy. Empiric antibiotic therapy is aimed at the organisms likely to be involved, depending on the mechanism of infection, and is the same as that recommended for secondary
No comments:
Post a Comment