Subdiaphragmatic Abscess: Complication of Emergency Laparotomy

Abstract

Intra-abdominal abscesses usually occur following any intra-abdominal surgery, trauma, Gastrointestinal infection or intestinal perforation. In particular, the diagnosis of sub-phrenic collection can be notoriously difficult. This fact is expressed by the well-known aphorism: 'Pus somewhere, pus nowhere else, pus under the diaphragm'. Sub-diaphragmatic abscesses form between the diaphragm and abdominal organs, such as the liver and spleen. Depending on the severity of the sub-diaphragmatic abscess and the cause, treatment method may vary for each case. The abscess may be treated with early percutaneous drainage and empiric intravenous antibiotics. When dealing with post-operative persistent pyrexia that does not react to antibiotics, surgeons must always be careful, and the likelihood of a sub-diaphragmatic abscess must always be considered. If not treated, thoracic and abdominal complications may prevail, in rare cases, death. We present a case of sub-diaphragmatic abscess in a patient with a perforated duodenal ulcer treated by ultrasound-guided percutaneous drainage with a good outcome.