Subphrenic abscess

Introduction to underarm abscess Where the diaphragm is below the diaphragm, the localized empyema in the area above the transverse colon and its mesentery is called subphrenicabscess, and the right posterior interhepatic abscess is the most common. The reason is related to lymphatic flow and respiratory movement. The intra-abdominal pressure in the gap was the lowest, followed by the right hepatic space and the right hepatic anterior space abscess. The left axillary abscess was relatively rare. The underarm abscess is a secondary infection, and its location is related to the primary disease. It can occur in one or two or more gaps. There are obvious systemic symptoms in the clinic, and local symptoms are hidden. Complications are high, the mortality rate is high, and early surgical drainage is required. basic knowledge The proportion of illness: 0.005% Susceptible population: patients after acute peritonitis or intra-abdominal surgery Mode of infection: non-infectious Complications: pleural effusion, intestinal fistula, gastrointestinal bleeding, anemia

The cause of underarm abscess

(1) Causes of the disease

The inferior peritoneal lymphatic network is rich, so the infection is easy to lead to the underarm. The underarm abscess can be caused by infection in any part of the body. Most of them are complications of abdominal purulent infection, which is common in acute appendicitis perforation. Perforation of intestinal ulcers, as well as acute inflammation of the liver and gallbladder, these often complicated right axillary infection.

Most of the pathogens causing abscesses come from the gastrointestinal tract, of which E. coli, anaerobic infections account for about 40%, streptococcus infections account for 40%, and staphylococcal infections account for about 20%, but most are mixed infections, and abscess formation The location depends on the source of the infected organ.

1. Left axillary abscess due to portal hypertension, splenectomy or shunt, spleen exudate, oozing, bacterial infection after devascularization surgery; or radical gastrectomy, gastrointestinal trauma, perforation of diffuse peritonitis, abdominal tumor After operation, left sulcus effusion, empyema; hemorrhagic necrotizing pancreatitis after non-surgical or surgical drainage.

2. Right axillary abscess due to stomach, duodenal ulcer perforation, diffuse peritonitis surgery, liver cancer, liver abscess and hepatobiliary trauma surgery, biliary tract, gallbladder surgery, duodenum, stomach infection, infection, infection , pus, exudate, bile, intestinal fluid accumulate in the liver, subhepatic space, forming a wrinkle abscess; also have perforation of appendix, diffuse peritonitis or gastrointestinal trauma.

(two) pathogenesis

1. When the patient is lying down, the lower part of the armpit is the lowest. In acute peritonitis, the pus in the abdominal cavity is easy to accumulate. The bacteria can also reach the armpit by the portal vein and lymphatic system. Before the abscess is formed, there is an inflamed stage of the armpit, about 70% acute. After surgery or drug treatment in patients with peritonitis, the pus in the abdominal cavity can be completely absorbed, and 30% of patients have localized abscess.

2. Small underarm abscess can be absorbed by non-surgical treatment. Large abscess can cause body exhaustion and exhaustion due to long-term infection. The mortality rate is very high. Underarm infection can cause reactive pleural effusion, or lymphatic route. Spread to the chest cavity to cause pleurisy; can also penetrate into the chest cavity to cause empyema, individual can penetrate the colon to form internal hemorrhoids and "home" drainage, but also due to abscess corrosion of the digestive tract wall caused by repeated bleeding of the digestive tract, intestinal fistula or stomach cramps Sepsis can occur if the patient's body resistance is low.

Underarm abscess prevention

1. Patients with peritonitis should take a semi-sitting position to avoid the upward flow of exudate in the abdominal cavity.

2. Use effective antibiotics after surgery.

3. Before abdominal surgery, the abdominal cavity exudate, pus and saline flushing solution should be fully absorbed.

4. If there is a wound in the abdominal cavity or a suspected anastomotic leakage, the drainage tube should be placed, and the semi-sitting position should be taken as soon as possible after the anesthesia is restored.

Subgingival abscess complications Complications, pleural effusion, intestinal fistula, gastrointestinal bleeding, anemia

1. Intrathoracic infection of the chest can cause reactive pleural effusion, or spread to the chest through the lymphatic pathway to cause pleurisy; can also penetrate into the chest to cause empyema.

2. Gastrointestinal hemorrhage and digestive tract sputum due to abscess can corrode the digestive tract wall and cause repeated bleeding of the digestive tract, intestinal fistula or stomach cramps.

3. Anemia.

Abdominal abscess symptoms Common symptoms Dull pain Continuous fever Fatigue Night sweats Underarm infection Relaxation fever Anorexia Reversing high heat debilitation

The diagnosis of underarm abscess is generally difficult, because the disease is secondary infection, often covered by the symptoms of the primary lesion, the primary lesion after treatment improved, and continued to have fever after a few days, fatigue, upper abdominal pain, should think of There is no underarm infection.

1. Systemic symptoms of fever, initially relaxation heat, persistent high fever after abscess formation, but also moderate to moderate fever, increased pulse rate, thick and greasy tongue coating, gradually appear fatigue, anemia, weakness, night sweats, anorexia, weight loss, The white blood cell count is increased and the proportion of neutrophils is increased.

2. Local symptoms of abscess may have persistent dull pain. The pain is often located under the costal margin of the near midline or under the xiphoid process. It is aggravated by deep breathing. The abscess is located in the lower part of the liver and may have kidney pain. Sometimes it may involve the shoulder and neck. Abscess stimulates the diaphragm to cause hiccups. Underarm infection can cause pleural and lung reactions through the lymphatic system, pleural effusion, cough, chest pain, abscess piercing into the chest cavity. In recent years, due to the large number of antibiotics, local symptoms are more typical. In severe cases, localized skin edema, skin temperature rises, the respiratory sounds below the affected chest weaken or disappear, and the right axillary abscess can enlarge the liver dullness, and 10% to 25% of the abscess contains gas.

Examination of the underarm abscess

1. White blood cell count and differential count The total number of white blood cells and neutrophils increased significantly, and the nucleus shifted to the left.

2. Bacteriology culture

(1) Blood culture: Those with severe symptoms of systemic poisoning should be bled for bacteriological culture, and a few may have positive.

(2) Pus culture: When the diagnostic puncture is performed, if the extract is pus, bacterial culture and drug sensitivity test should be carried out to guide the use of clinical antibiotics.

3. Red blood cells and hemoglobin in the elderly can continue to have a slight decrease in hemoglobin.

1. Imaging examination

(1) X-ray inspection:

1 chest and abdomen fluoroscopy and radiography: visible elevation of the diaphragm in the affected side, respiratory movement weakened or disappeared; the affected side of the rib angle was blurred or there was significant pleural effusion; there was a gas-liquid surface under the armpit (Figure 2).

2 barium meal examination: the left axillary abscess showed gastric pressure displacement (Figure 3).

(2) B-type ultrasound: There is a liquid level in the affected side of the armpit, which helps the diagnosis of abscess, accurate positioning, can be diagnosed by B-ultrasound, and the pus is sent to the bacterial culture and drug sensitivity test (Figure 4).

(3) CT scan: can determine the location, size and relationship of the abscess and the surrounding organs, the correct rate of diagnosis of abdominal abscess is up to 90%, especially suitable for obesity, flatulence and abdominal drainage tube are not suitable for ultrasound examination (Figures 5, 6).

Diagnosis and diagnosis of underarm abscess

diagnosis

1. History Most of the underarm abscesses have liver cancer, gastrointestinal tumors, acute diffuse peritonitis, abdominal trauma, a history of major abdominal surgery, but the liver abscess is worn out, and pus accumulation in the armpit is not uncommon.

2. High fever After the abdominal operation, the body temperature continues to drop or decline for several days. After 1 week or even 2 weeks, it gradually rises to above 39 °C. It continues to retreat, showing relaxation heat, rapid pulse, fatigue, no appetite, and a few. There is dull pain in the abdomen.

3. Physical examination of the affected side of the intercostal space, the lower back, the upper abdomen is often edema, the intercostal space is full, there is deep tenderness and snoring pain, the percussion of the liver dullness is enlarged, and the abdomen lower lung breath sounds weakened.

4. Auxiliary examination X-ray fluoroscopy showed that the diaphragmatic muscle of the affected side was elevated, with limited or disappeared respiratory activity, rib angle was blurred, effusion, X-ray showed pleural reaction, pleural effusion, partial atelectasis, etc.; Under the shadow of the occupying place, the abscess of the left axilla, the fundus can be depressed by the displacement; the abscess gas can have a liquid level, the diagnostic puncture is a purulent effusion, but the negative puncture can not rule out the possibility of abscess.

The diagnosis of underarm abscess is generally difficult because the disease is a secondary infection and is often masked by the symptoms of the primary lesion.

Differential diagnosis

Should be differentiated from the primary lesion, such as acute appendicitis perforation, perforation of gastroduodenal ulcer, and acute inflammation of the liver and gallbladder.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.