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Subphrenic abscess. The new epidemiology

S M Wang, S E Wilson

    Archives of Surgery (Chicago, Ill. : 1960)
    |August 1, 1977
    PubMed
    Summary
    This summary is machine-generated.

    Subphrenic abscess causes are shifting, with gastric/biliary surgery increasing and appendicitis decreasing. Treatment should target anaerobic bacteria and consider transperitoneal drainage for complex cases.

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    Area of Science:

    • Abdominal Surgery
    • Infectious Diseases
    • Surgical Microbiology

    Background:

    • Subphrenic abscesses represent a significant postoperative complication.
    • Understanding evolving trends in etiology, topography, and bacteriology is crucial for effective management.

    Purpose of the Study:

    • To analyze recent changes in the causes, locations, and bacterial profiles of subphrenic abscesses.
    • To update treatment recommendations based on current data.

    Main Methods:

    • Retrospective review of 93 patients treated for subphrenic abscess between 1955 and 1975.
    • Analysis of patient demographics, preceding operations, abscess characteristics, microbial flora, and outcomes.

    Main Results:

    • Gastric and biliary surgery are now the leading causes (52%), while appendicitis has decreased to 8%.

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  • Colonic surgery (19%) and trauma (8%) are emerging causes.
  • Predominant bacteria include Escherichia coli, Klebsiella, Proteus, Bacteroides, and various cocci and clostridia.
  • Overall mortality was 31%, higher in cases with multiple abscess spaces (39%) or after emergency procedures (35%).

    • Conclusions:

    • Antibiotic therapy should target anaerobic organisms.
    • Transperitoneal drainage is often indicated due to increased multiple abscesses and the need to assess prior surgical interventions.