Clinical History.—An 8-year-old girl was admitted to the hospital with acute peritonitis secondary to perforated appendix. The appendix was removed, the peritoneum was irrigated and drained, and the patient was treated with gentamicin sulfate (Garamycin) and clindamycin (Cleocin). She subsequently developed right upper and lower lobe infiltrates and left lower lobe atelectasis, which partially responded to penicillin therapy, postural drainage, and intermittent positive pressure breathing treatments. Despite appropriate antibiotic therapy, the child continued to have high spiking fever. Daily blood, urine, throat, and sputum cultures failed to disclose the growth of any organism. On the tenth postoperative day, roentgenograms were repeated.
Denouement and Discussion
Subphrenic Abscesses on the Left
The incidence of abscesses secondary to appendicitis is decreasing due to early recognition and surgical treatment, but it remains a common cause of intra-abdominal abscess. In a recent review of 6,041 cases, 1,567 were secondary to acute appendicitis, 1,774 to gastroduodena
Gwinn JL, Lee FA, Smedresman P. Radiological Case of the Month. Am J Dis Child. 1975;129(11):1333-1334. doi:10.1001/archpedi.1975.02120480049011