Subphrenic Abscess

Subphrenic Abscess


A pus-filled cavity in the subphrenic region which is the area below the diaphragm but above the colon and liver.

The infection can occur as a complication of abdominal surgery, acute pancreatitis and trauma.

Subphrenic abscess is toxemia

The most common intraperitoneal abscess following peritonitis is Subphrenic abscess




Upper abdominal pain

Breathing difficulty

Painful breathing

Referred shoulder pain



X-RAYS are essential. Screening is the most important investigation and the cheapest. Look for:

The failure of one side of his diaphragm to move.

This is a sign of infection, but not necessarily of an abscess.

Give him a little contrast medium, and look for downward and forward displacement of his stomach and spleen.

Also take a PA and a lateral view. Look for:

Raised diaphragm,

Fuzzy upper border to his diaphragm

Fluid in his costophrenic angle

Collapse or consolidation at one lung base

Fluid level (rare).

Gas in his subphrenic space.

This can be the residue from a laparotomy, or it can be due to a perforation of his gut, or to an anaerobic infection.

If his first X-ray examination is negative or equivocal, repeat it a few days later.


Surgical drainage of abscess and dead tissue removal

Chloramphenicol, metronidazole, gentamycin, tobramycin, amkiacin, clindamycin