A subhepatic abscess is a limited septic formation that 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, exacerbated by inhalation, fever, poisoning, dyspeptic disorders. Diagnosis is based on a detailed history of the anamnesis, the results of laboratory tests and other diagnostics. Surgical therapy consists in 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 (in ICD-10 code - K75.0) - more.
Varieties
An abscess of the subhepatic space can be both the initial inflammatory neoplasm, and the consequence of osumka exudate directly under the diaphragm.
Therefore, two types of this disease are distinguished:
- Primarily limited abscess: created against the background of the formation of a painful process near the organs located.
- Secondarily limited abscess: the pathogenic flora is in the area under the liver, since this is the area with the greatest resorption from the abdomen, subsequently, 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 inflammation of the appendix, perforation, various defects of the hollow or parenchymal organs, circulatory pathologies in the vessels of the mesentery of the intestinal tract with restrained hernias and constipation of the intestinal tract, operations. In addition, the disease can form with hematogenous and cryptogenic spilled peritonitis. Most of all, the association of microorganisms of the intestinal group and anaerobic bacteria is the infectious agent.
The formation of the disease is facilitated by the plastic properties of the peritoneum: due to a defect, fibrinous adhesive exudate accumulates on its plane, which leads to the connection of the 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 secondary subhepatic abscess, a significant role in pathogenesis is played by the large resorptive dynamics 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 peritoneal bag.
Signs of pathology
The medical situation of the 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 area of the back, shoulder blade or shoulder, the saturation of which increases with a deep breath. In addition, hyperthermia is typical (fever has an intermittent appearance), aches, palpitations, increased pressure. In severe cases, a whole reaction to suppuration is formed up to infection of the blood and cardiac arrest.
Symptoms of a subhepatic abscess may not be. In such cases, this disease is suspected by low-grade fever, leukocytosis and an increase in ESR in blood tests, as well as pathogenicity when palpating in the region of the right hypochondrium. Signs of a subhepatic abscess include vomiting, bloating, constipation; with large sizes of the abscess, symptoms of bowel obstruction are likely.
If a secondary isolated abscess is possible, in the medical picture it is preceded by special indicators of extensive peritonitis. Moreover, against the background of gradual improvement of the patient's condition, the development of an abscess leads to an increase in abdominal pain and intoxication.
Disease complications
The prognosis of the formation of a subhepatic abscess can be very negative, if you do not take all possible measures to cure it.
The consequences of an untreated liver disease:
- Peritonitis, a blood poisoning caused by damage to an abscess and the spread of necrotic materials into the abdominal cavity.
- Subdiaphragmatic abscess due to the formation of infection under the dome of the diaphragm.
- Pericarditis, pericardial tamponade of the heart due to ingestion of pus in the pericardial sac.
- Ascites.
- Hemorrhage due to increased increased pressure in the veins.
- Brain abscess.
- Septic obstruction of arteries in the lungs.
- The development of fistulas in the lungs and pleura due to the breakthrough of the abscess in the pleural cavity.
Diagnostics
Since the subhepatic abscess is difficult to differentiate from diseases that are similar in signs, it is important to correctly assess the patient's complaints and his anamnesis. The doctor finds out the nature of complaints, the presence of sources of infections, operations, injuries, serious illnesses.
Laboratory studies for the diagnosis of liver abscess will be the same as for other diseases.
Instrumental methods
Methods of instrumental diagnostics, in which the subhepatic abscess is visualized, are as follows:
- Radiography of the abdominal cavity reveals symptoms of ascites, the presence in the liver of a cavity with fluid and pus.
- Ultrasound diagnosis of the hepatobiliary system determines the size and location of the abscess cavity.
- MRI, MSCT of the abdominal cavity give an assessment of the location, number and scale of abscesses to clarify the cure strategy.
- A radioisotope scan of the liver reveals deficiencies in the blood supply to the liver, localization of the abscess.
- Diagnostic laparoscopy - through small incisions, a small video camera and devices allowing the drainage of the abscess are introduced into the abdominal cavity.
It is important to distinguish between the condition we are considering and acute mastogenic cholecystitis, pleurisy, subdiaphragmatic abscess. It is easy enough to distinguish a subhepatic abscess on an ultrasound if the doctor is qualified.
Disease therapy
A surgeon, a gastroenterologist treats a subhepatic abscess, and an infectious disease specialist if necessary. A typical strategy includes antibiotic therapy in combination with minimally invasive interventions.
Abscess drainage is indicated, for which purpose minimally invasive technologies are more often used today. Under the control of ultrasound, percutaneous abscess puncture is done, pus is aspirated. A special drainage system is placed in the deepening of the abscess, through which it is allowed to repeatedly wash the gastrocnemius cavity and inject antibacterial substances. The process is less traumatic and much easier to tolerate by patients than open surgery.
If this technology is unrealistic to use, the deepening of the abscess is opened and drained by the surgical method. Use both transperitoneal and extraperitoneal access according to Melnikov. The latter method is preferable, since it makes it possible to exclude massive enterobacterial seeding of the abdominal cavity.
Reviews
Patients are advised in time to treat diseases that provoke the formation of this pathology. Do not neglect the first signs of the disease and consult a doctor immediately.
Forecast
With timely detection and appropriate treatment, the prognosis is positive. A subhepatic abscess is capable of exacerbating 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 cure of diseases that can be an abscess factor, as well as painstaking postoperative observation of patients who have suffered peritonitis and other purulent lesions of the abdominal cavity organs.