Subphrenic abscess

Among the complications of ulcer disease in some cases there is subphrenic abscess, representing a collection of pus, often with gas, in the space between the diaphragm and the authorities of this region. A distinctive feature subphrenic abscess is that one of its walls is always aperture.
Localization should distinguish between 2 different types subphrenic abscess:
1. Subphrenic abscess in the true sense of the word. It is localized in subphrenic tissue behind the peritoneum, where, having spread through the lymph system, can turn into a retroperitoneal a phlegmon.
2. A collection of pus under the diaphragm into the peritoneal cavity. This type is better viewed as intra-abdominal abscess, residual ulcer after peritonitis.
Complication of peptic ulcer disease is often intra-abdominal option subphrenic abscess. It is important in the sense that it is easier to identify than ulcer, located in the lower abdomen.
The etiology and pathogenesis. Subphrenic abscess ulcers may form in the period of exacerbation in case of infection in the lymph pool gastric or duodenal ulcer or after covered, and retroperitoneal perforation or after perforation in the free abdominal cavity.
65% of all cases subphrenic abscess be due to peptic ulcer, cholecystitis, appendicitis or post-resection peritonitis. More common variant of intra-abdominal abscess. For its development there are 6 anatomic zones: 1) right front nadpochechnoj space, 2) right rear nadpochechnoj space, 3) the right subhepatic space, 4) left nadpochechnoj space, 5) left front subhepatic space, 6) left rear subhepatic space that freer other reported with peritoneal cavity. The left and right groups of these spaces are separated from each other sickle-shaped ligament, and the front and rear - coronary ligament of the liver.
Microbial flora usually corresponds to the flora of primary tumor and in most cases is represented Century coli, streptococcus, staphylococcus. Aperture is not an insurmountable barrier to the further spread of infection, and therefore subphrenic abscess is often combined with suppuration the left, then the right pleural cavity, in both simultaneously. Terms of formation of abscesses after inflammation different and vary between 10 and 20 days (C. M. Belgorod, 1964).
Pathological anatomy. Subphrenic abscess is most often single-chamber, occupying only one of the above mentioned spaces. However, sometimes there are multi ulcers. The possibility of multiple cameras explains the continuation of intoxication, despite the disclosure of the first detected the camera ulcer. Inside the abscess is lined with pyogenic shell. Usually the walls are thin and pliable and only in very severe cases are considerable thickness and density.
Classification. For practical purposes subphrenic ulcers vary according to the above 6 topographic spaces, which is important for the choice of access. The contents should be distinguished gas-free and containing gas ulcers.