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Article
April 1928

PERFORATION OF THE DIAPHRAGM: THE RESULT OF INTRA-ABDOMINAL SUPPURATION: REPORT OF UNUSUAL CASES

Author Affiliations

PHILADELPHIA
From the Laboratory of the Samaritan Hospital.

Arch Surg. 1928;16(4):864-867. doi:10.1001/archsurg.1928.01140040059002
Abstract

Ordinarily the diaphragm is considered an efficient barrier between the abdominal and pleural cavities, even in cases of suppuration. While infection may spread in either direction by way of the lymphatics, extension by loss in continuity of the diaphragm is rather unusual and is particularly uncommon in cases of acute generalized suppurative peritonitis. The following cases briefly illustrate three different types of intra-abdominal inflammation responsible for intrapleural suppurative conditions.

REPORT OF CASES 

Case 1.  —R. G., aged 44, had had a hysterectomy and a right salpingooophorectomy performed for a tubo-ovarian abscess which involved the tip of the appendix. Twenty-one days later, after a febrile course, a right perinephritic abscess was opened and drained. Intermittent pain persisted in the right side. Dulness developed at the base of the right lung, accompanied by an irritating, nonproductive cough. Later, a moderate amount of foul-smelling, purulent material was expectorated. The patient died on the

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