Absceso subfrénico en el contexto de lumbalgia y lectura analítica en la consulta de atención primaria / Subphrenic abscess in the context of low back pain and reading analytics in the primary care consultations

El espacio subfrénico se define como la zona situada debajo del diafragma y encima del colon transverso. La mayoría de los abscesos subfrénicos se deben a contaminación directa relacionada con la cirugía, enfermedad local o traumatismo, pero persisten aún los de causa no definida o desconocida. Es un trastorno poco frecuente diagnosticado en atención primaria. Alrededor del 55% de los abscesos subfrénicos asientan en el lado derecho, el 25% en el izquierdo y el 20% son múltiples. Estos se pueden extender a la cavidad torácica, donde producen en ocasiones empiema, absceso pulmonar o neumonía. La mortalidad de los abscesos subfrénicos oscila entre el 11 y el 31%, y se debe a la infección no controlada, desnutrición y complicaciones de la hospitalización prolongada, como infecciones nosocomiales. El drenaje percutáneo bajo guía ecográfica o tomografía computarizada representa hoy el tratamiento de elección junto con los antibióticos (AU)

The subphrenic space is defined as the area below the diaphragm and above the transverse colon. Most abscesses are due to direct subphrenic contamination associated with, surgery, local disease, or trauma, but the cause still remain undefined or unknown. It is a disease rarely diagnosed in primary care. About 55% of subphrenic abscesses are located on the right side, with 25% on the left, and 20% are multiple. These can be extended to the thoracic cavity, which sometimes produce empyema, lung abscess, or pneumonia. The mortality of subphrenic abscess is between 11%-31%, and may be due to uncontrolled infection, malnutrition, and complications of prolonged hospitalization, such as nosocomial infections. Ultrasound or computed tomography-guided percutaneous drainage is now the preferred treatment, combined with antibiotics (AU)

False aneurysm of a hepatic artery branch and a recurrent subphrenic abscess: two unusual complications after laparoscopic cholecystectomy.

Although laparoscopic cholecystectomy has become a safe and effective alternative for open cholecystectomy as treatment of symptomatic cholelithiasis, it may be followed by different complications. Two cases are presented with unusual complications after laparoscopic cholecystectomy. One patient was readmitted 11 days after laparoscopic cholecystectomy with severe upper abdominal pain and a false aneurysm of a branch of the right hepatic artery. The other patient developed a recurrent subphrenic abscess 10 months after the initial operation, which eventually was shown to be caused by a lost gallstone. Although these are rare complications of laparoscopic cholecystectomy, they should be recognized as potential causes of recurrent abdominal pain, even months after the procedure.

Nursing care of a patient with a subphrenic abscess.

A subphrenic abscess is an abscess which forms below the diaphragm and above the transverse colon. Patients in the postoperative period following gastric, esophageal or hepatic surgery are at risk of developing a subphrenic abscess especially if they are older, if they develop a leak at an anastomosis site or if there was a high operative blood loss. Nurses who are aware of high-risk patients should increase their observations of the signs and symptoms of early subphrenic abscess. Subphrenic abscesses are often managed on the general nursing units but signs of impending respiratory failure or circulatory collapse may warrant transfer of the patient to an intensive care unit. Nursing interventions are then focused on maintaining the body systems, evaluating the effects of the medical and nursing interventions and supporting the patient and family who may be very anxious at the severity of the unanticipated complication.

Subphrenic abscess: a pulmonary presentation.

A patient with subphrenic abscess can present with pulmonary or abdominal symptoms because of the location of the abscess adjacent to the diaphragm. This thoracoabdominal clinical complex has been described previously and, if chest symptoms predominate, may obscure the diagnosis of subphrenic abscess. The case of a patient with occult abdominal pathology who presented with respiratory complaints is discussed.