SUBPHRENIC abscess, although infrequent, is a grave complication of abdominal suppuration. During the past fifteen years, the introduction of antibiotic preparations and the use of an extraserous type of surgical drainage have contributed to the successful management of patients with subphrenic abscess. The mortality rate, however, remains higher than should reasonably be expected. There are many factors which contribute to a high mortality rate in this disease, and we believe that a discussion of such factors may be of benefit. Diagnosis has been notoriously difficult and localization of the abscess almost conjectural. The time interval between the onset of intraperitoneal suppuration and the diagnosis of subphrenic abscess is unduly long. A successful extraperitoneal drainage requires familiarity with the anatomy of the subdiaphragmatic spaces and careful avoidance of contamination of the pleural and peritoneal cavities.
This report includes 40 cases seen during the past twelve years at University Hospitals of Cleveland.