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A Case Report of Intradiaphragmatic Abscess

Summary

A 62-year-old patient developed a rare abscess (collection of pus) within the diaphragm muscle one year after gallbladder removal surgery. The abscess was caused by residual gallstones that triggered inflammation and infection. Surgeons successfully removed the pus using a combination of abdominal and chest surgery approaches, and the patient recovered fully without complications at follow-up.

Background

Intradiaphragmatic abscesses are extremely rare conditions with only five cases reported in English and Japanese literature as of November 2024. Their pathogenesis is not well understood due to the limited number of reported cases. This case describes a patient who developed an intradiaphragmatic abscess one year after cholecystectomy for acute cholecystitis.

Objective

To report a case of intradiaphragmatic abscess and demonstrate the utility of a combined abdominal and thoracic surgical approach for correct diagnosis and treatment of this rare condition.

Results

Surgical exploration revealed a localized 4×4 cm bulge in the right diaphragmatic dome containing 5 mL of whitish pus, which was drained. Pus culture was positive for Escherichia coli. The patient’s temperature normalized within one day post-surgery and remained well without recurrence at 18-month follow-up imaging.

Conclusion

A combined abdominal and thoracic approach is useful for diagnosing and treating intradiaphragmatic abscesses. When subdiaphragmatic abscess or pyothorax is suspected, the possibility of an intradiaphragmatic abscess should be considered, and continued follow-up of hepatic inflammatory pseudotumors may prevent abscess formation.
  • Published in:Surgical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40625538, DOI: 10.70352/scrj.cr.25-0095
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