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Subphrenic Abscess: The New Epidemiology

Subphrenic Abscess: The New Epidemiology Abstract • Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operations account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation. (Arch Surg 112:934-936, 1977) References 1. Sanders RC: The changing epidemiology of subphrenic abscess and its clinical and radiological consequences . Br J Surg 57:449-455, 1970.Crossref 2. Whipple AO: A study of subdiaphragmatic abscess, with an analysis of 32 cases . Am J Surg 40:1-6, 1926. 3. Ochsner A, Graves AM: Subphrenic abscess: An analysis of 3,372 collected and personal cases . Ann Surg 98:961-970, 1933.Crossref 4. Berens JJ, Gray H, Dockerty M: Subphrenic abscess . Surg Gynecol Obstet 96:463-470, 1953. 5. Barnard HL: An address on surgical aspects of subphrenic abscess . Br Med J 1:371-377, 1908.Crossref 6. Boyd DP: The subphrenic spaces and the emperor's new robes . N Engl J Med 275:911-917, 1966.Crossref 7. Lehman EP, Archer VW: Suprahepatic abscess . South Surg 6:407-421, 1937. 8. Ochsner A, DeBakey M: Subphrenic abscess: Collective review and analysis of 3,608 collected and personal cases . Surg Gynecol Obstet 66:426-437, 1938. 9. Halyasz NA: Subphrenic abscess: Myths and facts . JAMA 214:724-726, 1970.Crossref 10. Sherman NJ, Davis JR, Jesseph JE: Subphrenic abscess, a continuing hazard . Am J Surg 117:117-123, 1969.Crossref 11. Konvolinda CW, Olearczyh A: Subphrenic abscess . Curr Probi Surg , (January) 1972. 12. Stone HH, Kolb LD, Geheber CE: Incidence and significance of intraperitoneal anaerobic bacteria . Ann Surg 181:709-715, 1975.Crossref 13. Shea PC, Holden WD: Subphrenic abscess . Arch Surg 57:842, 1948.Crossref 14. Wetterfors J: Subphrenic abscess: A clinical study of 101 cases . Acta Chir Scand 117:388-408, 1959. 15. Dineen P, McSherry CK: Subdiaphragmatic abscess . Ann Surg 155:506-517, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Subphrenic Abscess: The New Epidemiology

Archives of Surgery , Volume 112 (8) – Aug 1, 1977

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1977.01370080032004
Publisher site
See Article on Publisher Site

Abstract

Abstract • Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operations account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation. (Arch Surg 112:934-936, 1977) References 1. Sanders RC: The changing epidemiology of subphrenic abscess and its clinical and radiological consequences . Br J Surg 57:449-455, 1970.Crossref 2. Whipple AO: A study of subdiaphragmatic abscess, with an analysis of 32 cases . Am J Surg 40:1-6, 1926. 3. Ochsner A, Graves AM: Subphrenic abscess: An analysis of 3,372 collected and personal cases . Ann Surg 98:961-970, 1933.Crossref 4. Berens JJ, Gray H, Dockerty M: Subphrenic abscess . Surg Gynecol Obstet 96:463-470, 1953. 5. Barnard HL: An address on surgical aspects of subphrenic abscess . Br Med J 1:371-377, 1908.Crossref 6. Boyd DP: The subphrenic spaces and the emperor's new robes . N Engl J Med 275:911-917, 1966.Crossref 7. Lehman EP, Archer VW: Suprahepatic abscess . South Surg 6:407-421, 1937. 8. Ochsner A, DeBakey M: Subphrenic abscess: Collective review and analysis of 3,608 collected and personal cases . Surg Gynecol Obstet 66:426-437, 1938. 9. Halyasz NA: Subphrenic abscess: Myths and facts . JAMA 214:724-726, 1970.Crossref 10. Sherman NJ, Davis JR, Jesseph JE: Subphrenic abscess, a continuing hazard . Am J Surg 117:117-123, 1969.Crossref 11. Konvolinda CW, Olearczyh A: Subphrenic abscess . Curr Probi Surg , (January) 1972. 12. Stone HH, Kolb LD, Geheber CE: Incidence and significance of intraperitoneal anaerobic bacteria . Ann Surg 181:709-715, 1975.Crossref 13. Shea PC, Holden WD: Subphrenic abscess . Arch Surg 57:842, 1948.Crossref 14. Wetterfors J: Subphrenic abscess: A clinical study of 101 cases . Acta Chir Scand 117:388-408, 1959. 15. Dineen P, McSherry CK: Subdiaphragmatic abscess . Ann Surg 155:506-517, 1962.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1977

References