Subphrenic abscess: comparison between operative and antibiotic management.

Abstract

Subphrenic abscess is still a significant hazard which complicates surgical procedures as well as certain abdominal catastrophes. This is a report of 88 patients with subphrenic abscess at St. Vincent's Hospital and Medical Center of New York from 1954 through 1971. There were 46 males and 42 females, ranging from 2 to 88 years. Operations on the stomach, duodenum and biliary tract were the major causes. The causative organisms in order of frequency were: E coli (41.6%), Staphylococcus (41.6%), Aerobacter aerogenes (23.3%), Proteus (20%), Streptococci (18.3%) and Pseudomonas (8.3%). Penicillin and tetracycline, the antibiotics most commonly chosen on an empiric basis, proved effective in only 38% of cases. On the other hand, kanamycin, chloramphenicol and cephalothin were effective in 90%, 85% and 70% of cases respectively. The overall mortality rate was 15%. Nine of the 21 patients (42.8%) treated with antibiotics alone died while 11 of 67 patients (10.6%) treated with antibiotics and surgical drainage died. Some of the latter deaths occurred in patients treated with prolonged antibiotic therapy and operated on only as a last resort. In this series subphrenic abscess was best treated by early surgical drainage combined with the use of appropriate antibiotics.

• Authors: E A Roberts, T F NEALON Jr
• Journal: Annals of surgery (Ann Surg) Vol. 180 Issue 2 Pg. 209-12 (Aug 1974) ISSN: 0003-4932 [Print] United States
• PMID: 4601985 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Kanamycin
• Chloramphenicol
• Colistin

Topics

• Abdominal Injuries (complications)
• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Child
• Child, Preschool
• Chloramphenicol (therapeutic use)
• Colistin (therapeutic use)
• Drug Resistance, Microbial
• Escherichia coli Infections (drug therapy, surgery)
• Female
• Humans
• Infant
• Kanamycin (therapeutic use)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Postoperative Complications
• Radiography
• Staphylococcal Infections (drug therapy, surgery)
• Subphrenic Abscess (diagnosis, diagnostic imaging, drug therapy, etiology, microbiology, mortality, surgery, therapy)
• Surgical Procedures, Operative (adverse effects)