Intraperitoneal Spread of Infections
A remarkable change in the epidemiology of subphrenic and subhepatic abscesses has occurred over the last several decades. In the past, the most common causes included perforations of anterior gastric or duodenal ulcers and rupture of a gangrenous appendix. Today, such abscesses are usually postoperative and are particularly frequent following cholecystectomy and gastric operations. In Wettefors’ series (22), biliary tract diseases and peptic ulceration were responsible for the great majority of abscesses, with acute appendicitis accounting for only 10%. In 60% of the total cases, however, the abscess occurred as a postoperative complication. Samuel et al. (21) have documented radio-logically that many of the cases of postoperative abscesses are secondary to anastomotic leaks. Wettefors has stressed that more prompt diagnosis currently in conditions such as peptic ulcer and appendicitis, leading to earlier surgical intervention, results in an increasing proportion of postoperative abscesses. Escherichia coli and other gram-negative bacteria are the dominant organisms now cultured, but streptococci and staphylococci still play an important role.
KeywordsIntraperitoneal Fluid Subphrenic Abscess Paracolic Gutter Intraperitoneal Pressure Subphrenic Space
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