Subhepatic abscess is a limited acute purulent formation, which is located between the liver and the loops of the intestinal tract and is a complication of surgical diseases of the abdominal cavity. Medical manifestations are pain in the right hypochondrium, aggravated by inhalation, fever, poisoning, dyspeptic disorders. Diagnosis is based on a detailed study of the anamnesis, the results of laboratory tests and other diagnostics. Surgical therapy consists of opening, draining and washing the affected cavity, as well as regular antibiotic therapy and detoxification measures.
More details about the clinic, diagnosis and treatment of subhepatic abscess (ICD-10 code - K75.0) - further.
Varieties
Abscess of the subhepatic space can be both an initial inflammatory neoplasm and a consequence of exudate encystationdirectly below the diaphragm.
Therefore, two types of this disease are distinguished:
- Primary limited abscess: created against the background of the formation of a painful process near the located organs.
- Secondary limited abscess: the pathogenic flora is in the area under the liver, as this is the area with the greatest resorption from the abdomen, later suppuration is localized due to the appearance of a connecting capsule of a purulent nature.
Disease factors
The disease is considered a complication of cholecystitis, pancreatic necrosis, acute purulent inflammation of the appendix, perforation, various defects of hollow or parenchymal organs, circulatory pathologies in the vessels of the mesentery of the intestinal tract with strangulated hernias and constipation of the intestinal tract, operations. In addition, the disease can form with hematogenous and cryptogenic diffuse peritonitis. The most infectious agent is the association of microorganisms of the intestinal group and anaerobic bacteria.
The plastic properties of the peritoneum contribute to the formation of the disease: due to a defect, fibrinous sticky exudate accumulates on its plane, which leads to the connection of sheets of serous tissue. Then the formation of connective tissue adhesions takes place, and the source of purulent inflammation is isolated from the abdominal part. In the case of a secondary subhepatic abscess, a significant role in the pathogenesis is played by a large resorptive dynamism of the peritoneum in the subhepatic space, which contributes to the accumulation of exudate in this area.with widespread peritonitis. There are also anatomical prerequisites for the development of the disease - the presence of a hepatic bag of the peritoneum.
Signs of pathology
The medical situation of a subhepatic abscess depends on the severity of the process and the underlying disease. A more frequent indicator is pain on the right under the rib, passing into the back, shoulder blade or shoulder area, the saturation of which increases with a deep breath. In addition, hyperthermia is typical (a feverish condition has an intermittent appearance), aches, a strong heartbeat, and an increase in pressure. In serious cases, a whole reaction to suppuration is formed up to blood poisoning and cardiac arrest.
Symptoms of a subhepatic abscess may or may not be present. In such cases, subfebrile body temperature, leukocytosis and an increase in ESR in blood tests, as well as pathogenicity when feeling in the right hypochondrium, help to suspect this disease. Signs of a subhepatic abscess include vomiting, bloating, constipation; with a large abscess, symptoms of intestinal obstruction are likely.
If a secondary isolated abscess is possible, in the medical picture it is preceded by special indicators of extensive peritonitis. At the same time, against the background of a gradual improvement in the patient's condition, the development of an abscess leads to an increase in abdominal pain and intoxication.
Complications of the disease
The prognosis for the formation of a subhepatic abscess can be very negative, if nottake all possible measures to cure him.
Consequences of untreated liver disease:
- Peritonitis, a blood infection resulting from an abscess rupturing and spreading necrotic material into the abdominal cavity.
- Subphrenic abscess due to infection under the dome of the diaphragm.
- Pericarditis, pericardial tamponade of the heart due to pus entering the pericardial sac.
- Ascites.
- Hemorrhage due to increased pressure in the veins.
- Brain abscess.
- Septic blockage of the arteries in the lungs.
- Development of fistulas in the lungs and pleura due to abscess rupture into the pleural cavity.
Diagnosis
Since a subhepatic abscess is difficult to differentiate from similar diseases, it is important to correctly assess the patient's complaints, his anamnesis. The doctor finds out the nature of complaints, the presence of sources of infections, operations, injuries, serious illnesses.
Laboratory studies for diagnosing a liver abscess will be the same as for other diseases.
Instrumental Methods
Methods of instrumental diagnostics, in which a subhepatic abscess is visualized, are as follows:
- X-ray of the abdominal cavity reveals symptoms of ascites, the presence of a cavity in the liver with fluid and pus.
- Ultrasound diagnosis of hepatobiliarysystem determines the size and location of the abscess cavity.
- MRI, MSCT of the abdominal cavity assess the location, number and extent of abscesses to refine the treatment strategy.
- Radioisotope scanning of the liver reveals deficiencies in the blood supply to the liver, localization of the abscess.
- Diagnostic laparoscopy - a small video camera and devices are inserted into the abdominal cavity through minor incisions to allow drainage of the abscess.
It is important to distinguish between the condition we are considering and acute purulent cholecystitis, pleurisy, subdiaphragmatic abscess. Distinguishing a subhepatic abscess on ultrasound is easy enough if the doctor is qualified.
Therapy of disease
The treatment of a subhepatic abscess is carried out by a surgeon, a gastroenterologist, and, if necessary, an infectious disease specialist. A typical strategy includes antibiotic therapy combined with minimally invasive interventions.
Drainage of an abscess is shown, for the purpose of which minimally invasive technologies are more often used in our time. Under the control of ultrasound study, a percutaneous puncture of the abscess is made, pus is aspirated. A special drainage system is placed in the recess of the abscess, through which it is allowed to repeatedly wash the purulent cavity and introduce antibacterial substances. The process is less traumatic and much easier for patients than open surgery.
If this technology is unrealistic to use, the deepening of the abscess is opened and drained with a surgicalmethod. Both transperitoneal and extraperitoneal access according to Melnikov are used. The latter method is preferable, as it makes it possible to exclude massive enterobacterial contamination of the abdominal cavity.
Reviews
Patients are advised to treat diseases that provoke the formation of this pathology in time. Do not neglect the first signs of the disease and immediately consult a doctor.
Forecast
With timely detection and appropriate treatment, the prognosis is positive. A subhepatic abscess can be aggravated by a breakthrough into the abdominal cavity with the formation of diffuse peritonitis and new sources of purulent inflammation, sepsis and multiple organ failure. In such cases, the prognosis is very negative. The prevention of this pathology consists in the appropriate treatment of diseases that can be a factor in the abscess, as well as painstaking postoperative monitoring of patients who have suffered peritonitis and other purulent lesions of the abdominal organs.
