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KMID : 0371319770190090047
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Journal of the Korean Surgical Society
1977 Volume.19 No. 9 p.47 ~ p.55
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Subphrenic Abscess
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兪炯/Yoo, Hyoung
李鐘賢/曺章煥/尹台潤/閔震植/Lee, Jong Hyun/Cho, Chang Hwan/Youn, Tae Yun/Min, Jin Sik
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Abstract
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Clinical records of 73 patients with subphrenic abscess that were admitted to Severance Hospital of Yonsei University between 1965 and 1974 were reviewed as follows:
1. Male to Female ratio was 2: 1. The 3rd decade was the, most common.
2. The most common primary disease was liver abscess, one-fifth of the patients, with peptic ulcer perforation and perforated appendicitis following- in decreasing order.
3. Surgery on the stomach and duodenum were the most commonly seen preceding operations.
4. The symptoms were primarily abdominal in 56%, thoracic in 4%, and combined in 34%. Four-fifths of the patients had intermittent high fever, abdominal pain, and more than half had a wound discharge.
5. Roentgenological examination showed abnormal findings in 90%. There was an elevation of the diaphragm in two thirds, pleural effusion in half, pneumonia and atelectasis in one-third, and an air-fluid level in more than half of the cases reviewed.
6. In bacterial cultures of the abscesses, E. coli, anaerobic Streptococci, Staphylococci, and Proteus were grown in decreasing cases.
7 The right subhepatic space was the most frequent abscess site observed in. 29% of, the cases, furthermore multiple synchronous abscesses were observed in 22°%0 of the cases.
8. Overall mortality was-14%:, Thirty-nine case were treated with a transperitoneil approach and its mortality, 10%, was more less than with other extraperitoneal approaches or antibiotics alone.
9. With the preceding operation the best time for drainage was at 1~2 weeks after original operation, but patients´ drained within I week all died.
10. The complication of subphrenic abscess most commonly seen was pyothorax with a mort-ality rate of 21% Another less commonly seen complication, septicemia, had a mortality rate of 100%.
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