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[Sub-phrenic abscess: 28 cases, one death (author's transl)]
Abstract:
28 patients were operated on for subphrenic abscess, one patient died. The author emphasises the disadvantages of excessive antibiotics. The diagnosis should be made early in order to avoid severe infective complications. The diagnosis is not difficult. It is nowadays facilitated by echotomography and scannography, which permit one to localise precisely the collection of pus and to detect multiple abscesses. The incision should carefully avoid crossing the peritoneal or pleural cavities. The quality and the permanence of the drainage are the key to success. One should therefore leave in position numerous aspiration drains. One should generally abstain from any suture or digestive anastomosis. It is sufficient to direct the digestive fistula, when present, towards the skin surface. But the best policy is to avoid this operative complication the origin of which is almost always a mistake in the design or installation of the drain at the end of various operations on the abdomen.
Insights
Early diagnosis and proper drainage are crucial for managing subphrenic abscesses. This study highlights avoiding excessive antibiotics and surgical complications for better patient outcomes.
Area of Science:
- Abdominal Surgery
- Infectious Diseases
- Diagnostic Imaging
Context:
- Subphrenic abscesses present a significant surgical challenge.
- Effective management requires timely diagnosis and appropriate intervention.
- Complications can arise from delayed diagnosis or suboptimal surgical techniques.
Purpose:
- To review the management of subphrenic abscesses.
- To emphasize early diagnosis and effective drainage strategies.
- To discuss the avoidance of common surgical pitfalls.
Summary:
- This study analyzed 28 patients undergoing surgery for subphrenic abscess, with one mortality.
- Early diagnosis, facilitated by imaging techniques like echotomography and scannography, is vital.
- Key surgical principles include precise incision, secure and permanent drainage with multiple aspiration drains, and generally avoiding sutures or digestive anastomosis.
Impact:
- Highlights the importance of diagnostic imaging in localizing abscesses.
- Stresses the critical role of surgical technique, particularly drainage, in patient recovery.
- Warns against excessive antibiotic use and advises on preventing iatrogenic complications.