Eight sub-spaces were considered: right subphrenic
, left subphenic, right subhepatic (hepatorenal pouch), left subhepatic, lesser sac (omental bursa), pre greater omentum, retro greater omentum and pelvic sub-space.
Some authors advocate that after each splenectomy, it should be mandatory to place the drain in the left subphrenic
space, sometimes even two drains in cases of the classic group, although there are authors who complain that the drain should not be placed routinely, but only in cases of pancreatic injury (15-17).
US of the abdomen is the preferred modality for gallbladder diseases but due to scarcity of reports on GA, it is often misread due to periportal tissue and subphrenic
folds often reported as gallbladder or calculi leading to unnecessary surgery as was the case with our patient whose US report showed contracted gallbladder with multiple echogenic foci most likely being calculi.8 As the radiological imaging for gallbladder has less than 100% sensitivity for identification of organ, diagnosis of GA is usually made during surgery.
Microwave procedure-related side effects, complications, and follow-up findings of the studied group Microwave Tumor Tumor ablation <3 cm 3-5 cm Item (n=59) (n=44) (n=15) Side effects Abdominal pain 40 (67.7%) 25 15 Fever 4 (6.7%) 2 2 Major and minor 2 (3.3%) 0 2 complications Abscess formation 1 (1.7%) 0 1 Abdominal wall skin burn 1 (1.7%) 0 1 Pleural effusion 0 (0%) 0 0 Subphrenic
collection 0 (0%) 0 0 Follow-up findings (n=59) Primary recurrence 3/59 (5%) 0 3 (20%) De novo lesions 8 (13.5%) 3 (6.9%) 5 (30%) Malignant PV thrombosis 2 (3.3%) 1 (2.3%) 1 (6.6%) Ascites 2 (3.3%) 1 (2.3%) 1 (6.6%) Primary technique 57/57 (100%) 44 (100%) 13 (86.6%) efficacy (1st 3 m) (*) Cancer-free success 46 (77.9%) 40 (90.9%) 6 (40%) (*) 3 m: 3 months
Other rare causes were Gastric perforation in 2 patients, Post-op intestinal leak in 5 patients, Ruptured abscess liver in 3 patients, Subphrenic
abscess in 1 patient, perforated cecal diverticulosis in 1 patient.
Abdominal X-ray revealed subphrenic
free air; thus, the patient was taken to surgery.
Important differential diagnoses of this radiographic sign include pneumoperitoneum and subphrenic
In addition, the right subphrenic
lucency is noted as potentially due to postoperative residual intraperitoneal gas.
Alcoholics, diabetics, and immunosuppressed patients remain at high risk of splenic abscess formation (6) and extension from a contiguous focus of infection (e.g., pancreatic, subphrenic
, and perinephric areas) can also cause suppurative splenic lesions.
* evaluate for fluid in the pleura, subphrenic
and hepatorenal areas (Morison's pouch) and around the kidney
However, our paper was focused on unusual and rare localization of pelvic (cervix, vagina, round ligaments, ureter, and nerves) and extrapelvic endometriosis, including subphrenic
fold and abdominal wall.
Moreover, splenectomy may lead to immediate postoperative complications, such as overwhelming postsplenectomy infection (OPSI), subphrenic
abscess formation, and hypercoagulability .