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August 1984

Eclectic Drainage of Subphrenic Abscesses

Author Affiliations

From the Surgical (Drs Serrano, Dahl, and Malt) and Medical (Dr Rubin) Services, and the Department of Radiology (Drs Ferrucci and Mueller), Massachusetts General Hospital; and the Departments of Surgery (Drs Serrano, Dahl, and Malt), Medicine (Dr Rubin), and Radiology (Drs Ferrucci and Mueller), Harvard Medical School, Boston.

Arch Surg. 1984;119(8):942-945. doi:10.1001/archsurg.1984.01390200060014

• In 196 cases of subphrenic abscess from 1964 through 1979, 56% were attributable to gastric, hepatic, and colonic disease or surgery. Posttraumatic abscesses in younger patients became more frequent. Synchronous suprahepatic and subhepatic abscesses or bilateral abscesses accounted for 19%. Streptococci, Escherichia coli, Klebsiella, and Bacteroides species were the most frequently isolated organisms. Although the overall mortality rate was 40%, the surgical mortality rate decreased from 33% initially to 17% recently. The mortality rate of transperitoneal drainage decreased from 41% to 16%. From 1980 through early 1983, a success rate of 84%, with no fatalities, was achieved in percutaneous radiologic drainage of 25 unilocular abscesses. At present, radiologically guided drainage should be considered for unilocular abscesses and some bilocular ones. Although extraperitoneal, extrapleural surgical drainage remains an expeditious form of treatment, it may give way to radiologic drainage. Transperitoneal drainage is preferable for multifocal abscesses and for many abscesses secondary to complications of intraabdominal surgery.

(Arch Surg 1984;119:942-945)

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