Intraperitoneal Spread of Infections

  • Morton A. Meyers


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, 60–71% of such abscesses are postoperative and are particulary frequent following gastric and biliary tract operations and colonic surgery.7,36,37 Many of the cases of postoperative abscesses are secondary to anastomotic leaks.34 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. The bacterial flora generally consists of multiple strains of aerobic and anaerobic organisms. The aerobes include particularly E. coli, Streptococcus, Klebsiella and Proteus; and the anaerobes Bacteroides and cocci.36


Left Gastric Artery Falciform Ligament Subphrenic Abscess Paracolic Gutter Intraperitoneal Pressure 
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  1. 1.
    Annotation: Subphrenic abscess: A changing pattern. Lancet 2: 301, 1970Google Scholar
  2. 2.
    Ascher NL, Ahrenholz DH, Simmons RL, et al: Indium111 autologous tagged leukocytes in the diagnosis of intraperitoneal sepsis. Arch Surg 114: 386–392, 1979PubMedCrossRefGoogle Scholar
  3. 3.
    Autio V: The spread of intraperitoneal infection. Studies with roentgen contrast medium. Acta Chir Scand Suppl 321: 1–31, 1964Google Scholar
  4. 4.
    Barnard HL: Surgical aspects of subphrenic spaces. Br Med J 1: 371–377, 1908PubMedCrossRefGoogle Scholar
  5. 5.
    Boyd DP: The anatomy and pathology of the subphrenic spaces. Surg Clin N Am 38: 619–626, 1958PubMedGoogle Scholar
  6. 6.
    Boyd DP: The subphrenic spaces and the emperor’s new robes. N Engl J Med 275: 911–917, 1966PubMedCrossRefGoogle Scholar
  7. 7.
    Connell TR, Stephens DH, Carlson HC, et al: Upper abdominal abscess: A continuing and deadly problem. Am J Roentgenol 134: 759–765, 1980CrossRefGoogle Scholar
  8. 8.
    Dineen P, McSherry CK: Subdiaphragmatic abscess. Ann Surg 155: 506–517, 1962PubMedCrossRefGoogle Scholar
  9. 9.
    Drye JC: Intraperitoneal pressure in the human. Surg Gynecol Obstet 87: 472–475, 1948PubMedGoogle Scholar
  10. 10.
    Forgacs P, Wahner HW, Keys TF, et al: Gallium scanning for the detection of abdominal abscesses. Am J Med 65: 949–954, 1978PubMedCrossRefGoogle Scholar
  11. 11.
    Gerzof SG, Robbins AH, Birkett DH: Computed tomography in the diagnosis and management of abdominal abscesses. Gastrointest Radiol 3: 287–294, 1978PubMedCrossRefGoogle Scholar
  12. 12.
    Gerzof SG, Robbins AH, Birkett DH, et al: Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. Am J Roentgenol 133: 1–8, 1979CrossRefGoogle Scholar
  13. 13.
    Haaga JR, Weinstein AJ: CT-Guided percutaneous aspiration and drainage of abscesses. Am J Roentgenol 135: 1187–1194, 1980CrossRefGoogle Scholar
  14. 14.
    Harley HRS: Subphrenic abscess, with particular reference to the spread of infection. Hunterian Lecture. Ann R Coll Surg Engl 17: 201–224, 1955PubMedGoogle Scholar
  15. 15.
    Hellmer H: Die Konturen des rechten Leberlappens beim Ascites. Acta Radiol 23: 533–540, 1942CrossRefGoogle Scholar
  16. 16.
    Hopkins GB, Kan M, Mende CW: Early 67Ga scintigraphy for the localization of abdominal abscesses. J Nucl Med 16: 990–992, 1975PubMedGoogle Scholar
  17. 17.
    Jorulf H: Roentgen diagnosis of intraperitoneal fluid. A physical, anatomic, and clinical investigation. Acta Radiol Suppl 343, 1975Google Scholar
  18. 18.
    Knochel JQ, Koehler PR, Lee TG, et al: Diagnosis of abdominal abscesses with computed tomography, ultrasound, and 111In leukocyte scans. Radiology 137: 425–432, 1980PubMedGoogle Scholar
  19. 19.
    Kumar B, Alderson PO, Geisse G: The role of Ga-67 citrate imaging and diagnostic ultrasound in patients with suspected abdominal abscesses. J Nucl Med 18: 534–537, 1977PubMedGoogle Scholar
  20. 20.
    Livingston EM: A Clinical Study of the Abdominal Cavity and Peritoneum. Paul B Hoeber, New York, 1932Google Scholar
  21. 21.
    Love L, Demos TC, Reynes CJ, et al: Visualization of the lateral edge of the liver in ascites. Radiology 122: 619–622, 1977PubMedGoogle Scholar
  22. 22.
    Meyers MA: Roentgen significance of the phrenicocolic ligament. Radiology 95: 539–545, 1970PubMedGoogle Scholar
  23. 23.
    Meyers MA: The spread and localization of acute intraperitoneal effusions. Radiology 95: 547–554, 1970PubMedGoogle Scholar
  24. 24.
    Meyers MA: Peritoneography: Normal and pathologic anatomy. Am J Roentgenol 117: 353–365, 1973CrossRefGoogle Scholar
  25. 25.
    Meyers MA: Abdominal abscesses. Pp 186–190 in Radiology Today. Edited by MW Donner, FHW Heuck, Springer-Verlag, Berlin, Heidelberg, 1981CrossRefGoogle Scholar
  26. 26.
    Meyers MA, Whalen JP: Radiologic aspects of intraabdominal abscesses, The Diagnosis and Treatment of Intraabdominal Abscesses. Edited by I Ariel, K Kazarian. Williams & Wilkins, Baltimore, 1971Google Scholar
  27. 27.
    Mitchell GAG: The spread of acute intraperitoneal effusions. Br J Surg 28: 291–313, 1940CrossRefGoogle Scholar
  28. 28.
    Morison R: The anatomy of the right hypochondrium relating especially to operations for gallstones. Br Med J 2: 968, 1894Google Scholar
  29. 29.
    Myerson PJ, Myerson D, Spencer RP: Anatomic patterns of Ga-67 distribution in localized and diffuse peritoneal inflammation: Case report. J Nucl Med 18: 977–980, 1977PubMedGoogle Scholar
  30. 30.
    Ochsner A. DeBakey M: Subphrenic abscess: Collective review and an analysis of 3,608 collected and personal cases. Int Abstr Surg 66: 426–438, 1938Google Scholar
  31. 31.
    Ochsner J, Graves B: Subphrenic abscess. Ann Surg 98: 961–990, 1933PubMedCrossRefGoogle Scholar
  32. 32.
    Overholt RH: Intraperitoneal pressure. Arch Surg 22: 691–703, 1931.CrossRefGoogle Scholar
  33. 33.
    Salkin D: Intraabdominal pressure and its regulation. Am Rev Tubercu 30: 436–457, 1934Google Scholar
  34. 34.
    Samuel E, Duncan JG, Philip T, et al: Radiology of the postoperative abdomen. Clin Radiol 14: 133–148, 1963PubMedCrossRefGoogle Scholar
  35. 35.
    Taylor KJW, Sullivan DC, Wasson JF, et al: Ultrasound and gallium for the diagnosis of abdominal and pelvic abscesses. Gastrointest Radiol 3: 281–286, 1978PubMedCrossRefGoogle Scholar
  36. 36.
    Wang SMS, Wilson SE: Subphrenic abscess: The new epidemiology. Arch Surg 112: 934–936, 1977PubMedCrossRefGoogle Scholar
  37. 37.
    Wetterfors J: Subphrenic abscess: A clinical study of 101 cases. Acta Chir Scand 117: 388–408, 1959PubMedGoogle Scholar
  38. 38.
    Whalen JP, Bierny JP: Classification of perihepatic abscesses. Radiology 92: 1427–1437, 1969PubMedGoogle Scholar
  39. 39.
    Wolverson MK, Jagannadharao B, Sundaram M, et al: CT as a primary diagnostic method in evaluating intraabdominal abscess. Am J Roentgenol 133: 1089–1095, 1979CrossRefGoogle Scholar
  40. 40.
    Wooler AH: Subphrenic abscess. Thorax 11: 211–222, 1956PubMedCrossRefGoogle Scholar
  41. 41.
    Yeh H-C, Wolf BS: Ultrasonography in ascites. Radiology 124: 783–790, 1977PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1982

Authors and Affiliations

  • Morton A. Meyers
    • 1
  1. 1.Department of Radiology, School of MedicineState University of New York at Stony BrookStony BrookUSA

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