Subphrenic Abscess

Excerpt

Described by Barlow in 1845, a subphrenic abscess occurs when pus accumulates in the space between the diaphragm and the organs beneath it, such as the liver and spleen, and can have severe clinical consequences. A subphrenic abscess is characterized by abdominal pain, malaise, and fever and is accompanied by clinical and diagnostic evidence of infection. Von Volkman performed the first surgery to address a subphrenic abscess in 1879 through a combined abdominal and thoracoscopic exploration.

Frequently, a subphrenic abscess develops from abdominal surgery, trauma, or local inflammation and localizes in the spaces between the liver, intestines, and lungs, making drainage a challenging procedure. Clinical signs may often be delayed or subtle, and the diagnosis can be challenging. An aphorism developed for the subphrenic abscess is: "pus somewhere, pus nowhere else, pus under the diaphragm."