Subphrenic Abscess

Prior abdominal surgery, either open or laparoscopic

Blunt or penetrating trauma

GI perforation (malignancy, appendicitis, diverticulitis)

Inflammatory bowel disease

Immunocompromised pt

Developing sepsis

Respiratory compromise (pleural effusion, atelectasis, V/Q mismatching, ARDS)

• Preop ileus/bowel obstruction; aspiration risk

• Sepsis, including septic shock and associated renal failure and/or coagulopathy

• Increased capillary permeability (hypovolemia)

• High-output cardiac failure/LV dysfunction

Lyte and acid-base disturbances

Classic findings include fever, leukocytosis, and abdominal pain.

Associated findings include atelectasis, pleural effusions, elevated diaphragm, ipsilateral shoulder pain, and/or hiccups secondary to diaphragmatic irritation.

May be right- or left-sided, or both; above or below the liver or spleen.

Fistulas may form to any abdominal or thoracic organ, including pericardium or bronchi.

Disease severity ranges from mild to moribund.