Subphrenic abscess

Subphrenic abscess - encysted a collection of pus between the bottom surface of the aperture and the top surface of the liver (on the right) or the body of the stomach and spleen (left). More common right subphrenic abscess. Source subphrenic abscess are pockets of purulent inflammation of the abdominal cavity (perforated ulcer of stomach and duodenal ulcers, inflammation of the biliary tract and pancreas, liver abscess, acute appendicitis, amoebic dysentery, festering Echinococcus cyst), sometimes the lungs and pleura. The reason of education subphrenic abscess can be open and closed abdominal trauma, thoraco-abdominal injuries. Most often subphrenic abscess is located intraperitoneally.
The clinical picture subphrenic abscess is often erased, as it usually appears on the background of severe disease. The most typical prolonged fever, chills, poor sleep and appetite, weakness, depression psyche. The patient takes forced poluciaetsea position. A gentle breathing. At a palpation of the abdomen muscle tension and pain in the right hypochondrium, percussion - increase of the borders of the liver. In blood leukocytosis, acceleration ROHE. In more severe cases, symptoms subphrenic abscess are pain in the right hypochondrium, worse with deep breathing, coughing, sharp movements, iradierea in the girdle, the right clavicle, scapula, fever, leukocytosis. X-ray examination if subphrenic abscess plays a crucial role (the dome of the diaphragm is elevated, motionless; under it - gas and horizontal fluid level).
Complications subphrenic abscess: reactive pleurisy, a breakthrough of pus in the pleural or abdominal cavity, in the pericardium. Forecast serious, without surgery usually ends in death.
The main method of treatment subphrenic abscess is surgical. Diagnostic puncture is valid only on the operating tablethat upon receipt of pus from subphrenic space immediately begin operations. Access to subphrenic the abscess through the chest transpleural and vneplevralny. After draining the abscess is a cavity it is drained by and introduce tampons with Vishnevsky ointment and rubber drainage. First time tampons change on the 5-7th day.
In the postoperative period shows the use of antibiotics, vitamins, control x-ray of the chest and abdominal cavity. The necessary change of bandages that can get wet in connection with purulent discharge, and skin care: lubrication sterile vaseline, paste Lassara.

Subphrenic abscess (subdiaphragmatic abscess) - a limited collection of pus in subphrenic space between the aperture and adjacent to the lower of its surface bodies, mainly the liver on the right, stomach and spleen on the left.
Subphrenic space above the liver is divided suspend one ligament of the liver (lig. suspensorium hepatis) on the most right and lower left isolated from each other half.
Coronary ligament of the liver (lig. coronarium hepatis) dissociates subphrenic the crack in the back and two triangular ligament (lig. triaagulare dext. et sin.) - laterally. In normal left under the dome of the diaphragm also there is a gap between the aperture and adjacent to the lower surface of the stomach and spleen. These slots are reported with the abdominal cavity, representing essentially part thereof; and only when the inflammatory process at any site subphrenic space formed very early spikes that area of infection quickly distinguished from free abdominal cavity. Described areas subphrenic space are not connected, and therefore suppurative process in one of them usually does not apply to others.
There are the following localization subphrenic abscess: the top-right-front; the right verkhnesadsky; left verkhnesadsky. In addition, there are the extrahepatic P. A. In the upper floor of the abdominal cavity above the transverse colon rectum and mesocolon: right nizhnebakansky; left nipperdey (pregledanih); the bottom left rear (basedirectory). P. A. develops mainly in the subphrenic space, with about half of all ulcers is located in the upper-Adam space. The reason is that in the inflammatory process in one of abdominal lymph, and with it the infection go towards centrum tendineum diafragmatis and first of all infected right subphrenic space.
P. A. usually occurs in 30-50 years of age, 3 times more frequent in men than in women. However, P. A. can develop in childhood and old age, but much less frequently.
Subphrenic abscess, as a rule, is a complication of inflammatory processes in the abdominal cavity: ruptured appendicitis, perforative ulcers stomach and duodenal ulcers, severe forms of acute cholecystitis and cholangitis. Less P. A. develops when paranemia, even rarer when the General purulent processes, pielii. Finally, P. A. may develop as a result of a breakthrough intrahepatic abscess, when the wounds of the liver, after thoracoabdominal injuries.