The subphrenic spaces are 7 in number:
Four intraperitoneal spaces 2 in the Rt. Side & 2 in the left side.
1- Anterior: between Rt. lobe & diaphragm.
2- Posterior: between Rt lobe & Rt kidney (H.R. pouch)
3- Anterior: Between Lt. lobe & diaphragm.
4- Posterior: in lesser sac.
Three extraperitoneal Spaces:
Bare area of the liver and two perinephric spaces.
m Causes of subphrenic abscess:
1- Acute appendicitis (subhepatic).
2- Perforated peptic ulcer. 3- Acute cholecystitis.
4- Post operative infected haematoma.
5- Generalized peritonitis ® localized to suphrenic space.
mClinical picture:
"Fever of unknown etiology" "hectic fever"
PUS somewhere, PUS nowhere, Pus is there ® under diaphragm.
mInvestigations:
A- Plain x-ray þon abdomen in erect position
; Elevation of the copula of diaphragm.
; Gas with fluid level under diaphragm.
; Thickening of the copula of diaphragm.
; Sympathetic pleural effusion.
If all these data are present we can detect clinical 4 zones by percussion:
1- Resonance of the lung.
2- Dullness of the effusion.
3- Resonance of gas.
4- Dullness of the puss.
B- Ultrasonogrphy ® detect subphrenic collection and its "Site".
m Treatment:
Anterior abscess drained anteriorly. Posterior abscess drained posteriorly by resection of the last rib and extraserous drainage i.e. extrapleural and extraperitoneal.
SOURCE: DR. AYMAN SALEM'S BOOK
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