Subphrenic Abscess
- Etiology: Occurs 1–3 weeks post-op (e.g., splenectomy, gastrectomy, cholecystectomy) or post-peritonitis.
- Presentation
- Persistent fever, RUQ/LUQ pain, referred shoulder pain (Kehr sign), hiccups
- Sympathetic pleural effusion (dullness, decreased breath sounds at base).
- Not infection.
- Localized infection in the subphrenic space causes intense inflammation of the adjacent diaphragmatic peritoneum.
- This inflammation increases the vascular and lymphatic permeability of the diaphragm.
- Diagnosis:
- Initial: CXR (shows elevated hemidiaphragm, pleural effusion, subdiaphragmatic air-fluid level) or US.
- Best: CT abdomen/pelvis w/ IV contrast showing fluid collection w/ peripheral rim enhancement.
- Management:
- First-line: Broad-spectrum IV Abx (e.g., Zosyn) + percutaneous drainage (CT/US-guided).
- Second-line: Surgical drainage if percutaneous drainage fails, fluid is multiloculated, or pt is hemodynamically unstable.
- Complications: Sepsis, peritonitis, transdiaphragmatic spread (empyema).