Incision and drainage of posterior extraperitoneal subphrenic abscess

Right posterior interhepatic abscess, right subhepatic space abscess, and extraperitoneal space abscess can be treated with right posterior extraperitoneal incision and drainage. For the left hepatic posterior space abscess, left posterior extraperitoneal abscess can be used for incision and drainage. Treatment of diseases: abdominal abscess, underarm abscess Indication Right posterior interhepatic abscess, right subhepatic space abscess, and extraperitoneal space abscess can be treated with right posterior extraperitoneal incision and drainage. For the left hepatic posterior space abscess, left posterior extraperitoneal abscess can be used for incision and drainage. Contraindications There are major diseases in the liver. Preoperative preparation 1) Generally no special preparation is required. For patients with poor general condition, supportive care should be taken, including nutrition, infusion and antibiotics. Blood transfusion if necessary. (2) Ultrasound examination to determine the location of the abscess. Surgical procedure 1. Position: The left side is lying, the healthy side is down, slightly inclined forward by about 15°. Use a sandbag to pad the waist and make a mark on the spine of the first lumbar spine. 2. Incision: An oblique or arc incision is made from the plane of the spine of the thoracic 12 lumbar 1 to the posterior tibial line. Cut the skin, subcutaneous tissue, open the latissimus dorsi and lower serratus (can be cut if necessary), reveal and remove part of the 12th rib under the periosteum. When peeling the periosteum, pay attention to the upper and inner faces of the ribs to avoid damage to the pleura. After the ribs were removed, the periosteum of the 12th rib was cut in the plane of the first lumbar spine, and the intercostal vessels were sutured to expose the deep diaphragm. The diaphragm was cut at the attachment of the spine, which is the upper area of the fat sac around the kidney. . The fat around the kidney is bluntly separated, that is, the posterior wall of the renal capsule. 3. Drainage: Use a finger to probe the abscess, such as the interhepatic space, the abscess is on the upper side, the peritoneum can be peeled off from the face with fingers, and separated upwards; if it is under the liver, it can be separated downward before the upper pole of the kidney. Then, the puncture is tested again. If the pus is pumped, it can be cut along the puncture needle. After the incision, the hemostatic forceps were used to separate the abscess, and then the finger was inserted into the abscess to separate the fibrous septum for adequate drainage. Put 2 to 3 cigarettes into the abscess, if the cavity is large, you can use soft hose drainage. complication Infection in other parts.