subdiaphragmatic infection
Introduction
Introduction The underarm abscess is a secondary infection, and its location is related to the primary disease. The localized empyema located below the diaphragm, in the transverse colon and above the mesentery is collectively referred to as the subphrenic abscess. The right posterior interhepatic abscess is the most common, and the cause is related to the influence of lymphatic flow and respiratory movement. The intra-abdominal pressure in this space of the abdominal cavity is the lowest. Followed by the right subhepatic space and the right upper anterior space abscess, the left axillary abscess is relatively rare.
Cause
Cause
(1) Causes of the disease
The underlying peritoneal lymphatic network is rich, so the infection is easy to lead to the underarm, and the underarm abscess can be secondary to infection in any part of the body. Most are complications of abdominal purulent infection. Common in acute appendicitis perforation, perforation of gastroduodenal ulcer, and acute inflammation of the liver and gallbladder, these often complicated right axillary infection. Most of the pathogens causing abscesses are from the gastrointestinal tract, of which E. coli, anaerobic infections account for about 40%, streptococcus infections account for 40%, and staphylococcal infections account for about 20%. But most are mixed infections. The location of its abscess depends on the source of the infected organ.
Left underarm abscess
Multi-door hypertensive splenectomy or shunt, interrupted surgery, spleen exudate, oozing, bacterial infection; or radical gastrectomy, gastrointestinal trauma, perforation of diffuse peritonitis, left aortic space after abdominal tumor surgery Fluid, empyema; hemorrhagic necrotizing pancreatitis after non-surgical or surgical drainage.
2. Right axillary abscess
Due to perforation of stomach and duodenal ulcer, diffuse peritonitis, liver cancer, liver abscess and hepatobiliary trauma after surgery, biliary and gallbladder surgery, duodenum, stomach infection, infection, pus, exudate Bile, intestinal fluid accumulate in the liver, subhepatic space, forming a wrinkle abscess; also caused by perforation of appendix, diffuse peritonitis or gastrointestinal trauma.
(two) pathogenesis
1. When the patient is lying down, the lower part of the armpit is the lowest. In acute peritonitis, the pus in the abdominal cavity is easy to accumulate here. Bacteria can also reach the armpits from the portal vein and lymphatic system. Before the formation of abscess, there is a stage of infraorbital inflammation. After surgery or drug treatment in about 70% of patients with acute peritonitis, the pus in the abdominal cavity can be completely absorbed, and 30% of patients have localized abscess.
2. Small underarm abscess can be absorbed by non-surgical treatment. Large abscesses can cause exhaustion and exhaustion due to long-term infection, and the mortality rate is very high. Infraoral infection can cause reactive pleural effusion, or spread to the chest through the lymphatic pathway to cause pleurisy; can also penetrate into the chest to cause empyema. Individual penetrating colons form internal hemorrhoids and "home" drainage. There are also cases of repeated bleeding, intestinal fistula or stomach cramps caused by abscess corrosion of the digestive tract wall. Sepsis can occur if the patient's body resistance is low.
Examine
an examination
Related inspection
Blood routine abdominal plain film abdominal perspective chest perspective abdominal vascular ultrasound
Clinical symptoms
The diagnosis of underarm abscess is generally difficult because the disease is a secondary infection and is often masked by the symptoms of the primary lesion. After the treatment of the primary lesion improved, a few days later there was persistent fever, fatigue, pain in the upper abdomen, and should have thought of whether there was an underarm infection.
Systemic symptoms
Fever, initial relaxation heat, persistent high fever after the formation of abscess, can also be moderate to sustained fever. The pulse rate is increased and the tongue is thick and greasy. Gradually, fatigue, anemia, debilitation, night sweats, anorexia, weight loss, increased white blood cell count, and increased proportion of neutrophils.
2. Local symptoms
There may be persistent dull pain in the abscess, and the pain is often located under the costal margin of the near midline or under the xiphoid process, which is exacerbated by deep breathing. The abscess is located in the lower part of the liver and can have kidney pain, sometimes involving the shoulder and neck. Abscess stimulation of the diaphragm can cause hiccups. Infraorbital infection can cause pleural and lung reactions through the lymphatic system, pleural effusion, cough, chest pain. The abscess penetrated into the chest and the empyema occurred. In recent years, due to the large number of antibiotics applied, local symptoms are more atypical. In severe cases, localized skin edema and elevated skin temperature. The breath sound below the chest of the affected side weakens or disappears. The right axillary abscess can enlarge the dullness of the liver. 10% to 25% of the abscess contains gas.
3. Medical examination
The flank of the affected side, the lower back, the upper abdomen are often edema, the intercostal space is full, and there is deep tenderness and sputum pain. In the percussion, the dullness of the liver was enlarged, and the aspiration sound of the lower lung was weakened.
4. Auxiliary inspection
X-ray fluoroscopy showed that the diaphragm of the affected side was elevated, with limited or disappeared respiratory activity, and the rib angle was blurred and effusion. X-ray showed pleural reaction, pleural effusion, partial atelectasis of the lower lung, etc.; Left axillary abscess, the fundus can be reduced by pressure displacement; abscess gas can have a liquid level. Diagnostic puncture is a purulent effusion, but the negative puncture can not rule out the possibility of abscess.
Diagnosis
Differential diagnosis
First, the differential diagnosis of underarm infection:
The diagnosis of underarm infection is generally difficult, because the disease is a secondary infection, often covered by the symptoms of the primary lesion, it should be differentiated from the primary lesion, such as acute appendicitis perforation, perforation of gastroduodenal ulcer, and Acute inflammation such as liver and gallbladder.
Second, the diagnosis:
History
Most underarm abscesses have a history of liver cancer, gastrointestinal tumors, acute diffuse peritonitis, abdominal trauma, and major abdominal surgery, but it is not uncommon for the liver abscess to break through and the pus accumulates under the armpit.
2. High fever
After abdominal surgery, the body temperature continued to decrease or decreased for several days, 1 week or even 2 weeks, and then gradually rose to above 39 °C, and continued to retreat, showing relaxation heat. The pulse is fast, weak, and has no appetite. A few have a dull pain in the upper abdomen.
3. Medical examination
The flank of the affected side, the lower back, the upper abdomen are often edema, the intercostal space is full, and there is deep tenderness and sputum pain. In the percussion, the dullness of the liver was enlarged, and the aspiration sound of the lower lung was weakened.
4. Auxiliary inspection
X-ray fluoroscopy showed that the diaphragm of the affected side was elevated, with limited or disappeared respiratory activity, and the rib angle was blurred and effusion. X-ray showed pleural reaction, pleural effusion, partial atelectasis of the lower lung, etc.; Left axillary abscess, the fundus can be reduced by pressure displacement; abscess gas can have a liquid level. Diagnostic puncture is a purulent effusion, but the negative puncture can not rule out the possibility of abscess.
