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[Subphrenic abscess due to ectopic appendicitis]
J N Di Marco1, A Poujol, Y Rimet
1Service de pédiatrie, centre hospitalier du Pays d'Aix, Aix-en-Provence, France.
Insights
Idiopathic subphrenic abscesses are rare in children. Ectopic appendicitis is a key cause, often requiring surgical intervention after initial drainage.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Subphrenic abscesses are uncommon pediatric conditions.
- Initial diagnosis often relies on chest X-rays.
- Percutaneous drainage is a common initial treatment.
Observation:
- A 12-year-old boy presented with symptoms suggestive of a pulmonary abscess.
- Imaging studies including chest X-ray, ultrasonography, and CT confirmed a right subphrenic abscess.
- The abscess was successfully drained percutaneously.
Findings:
- Subsequent surgery revealed an ectopic appendiceal perforation as the underlying cause.
- Appendicitis is identified as the primary etiology for subphrenic suppurations in children.
- Ectopic appendicitis is a significant predisposing factor.
Implications:
- Highlights the importance of considering appendicitis, particularly ectopic presentations, in pediatric subphrenic abscesses.
- Suggests that surgical exploration may be necessary when the etiology remains unclear after initial drainage.
- Emphasizes the role of advanced imaging in diagnosing these complex cases.
Background:
Idiopathic subphrenic abscesses are uncommon in children. Standard chest X-rays may provide the suspicion of this diagnosis. Initial percutaneous drainage of the collection is usually performed. Surgery is required when the underlying cause remains unknown.
Case Report:
A 12-year-old boy presented signs of pulmonary abscess. Chest X-rays, ultrasonography and computed tomography established the diagnosis of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation.
Conclusion:
In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication.