Factors contributing to subphrenic abscess

Between 1969 and 1982 11 primary (without previous surgery) and 38 secondary (postoperative) subphrenic abscesses were treated out of total 20800 operations. The patients had on an average more than 4 risk factors. Causes contributing to the formation of secondary abscesses were a difficult operation in 42%, deficiencies in surgical technique in 26%, operative contamination in 21% and peritonitis in 13% of the cases. Clear problems in the primary operation were found in 23 of 38 patients and in 6 of 7 patients who died with a later secondary abscess. It seems probable that subphrenic abscesses are more likely to develop in high risk patients after a difficult and/or contaminated operation.