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Left Subdiaphragmatic Abscess * : Report of a Case

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LEFT SUBDIAPHRAGMATIC ABSCESS* REPORT OF A CASE GERVASE J. CONNOR Subdiaphragmatic abscess on the left frequently exhibits a course different from that of a similar condition on the right. Elevation of the adjacent leaf of the diaphragm may be a late sign, since the stomach is relatively mobile; ipsilateral basilar pulmonary atelectasis and pleural effusion may also be delayed in appearance under these circumstances. It is, therefore, a point of particular importance that one should not await the full development of these signs in order to make a proper diagnosis. Such delay imposes a serious increase in risk in that the patient is brought to operation with late compli- cations. This circumstance contributes both to an inordinately high mortality rate and to a prolonged convalescence. The following case exhibits clearly the course of a carefully observed left subdiaphragmatic abscess in which operation was delayed. 4. M. (New Haven Hospital No. B25520). This 59-year-old white female was admitted to the Hospital on March 8, 1942, complaining of vomiting and of pain in the left shoulder and abdomen. Except for a mild nocturia (1-2) for six months, she had previously been well. History Present illness. One month before admission she suffered a short bout of cramp-like abdominal pain, associated with vomiting. She recalled little else of this illness which promptly cleared within 24 hours. Diabetes mellitus was discovered at this time and was rather easily controlled 'by dietary regula- tion without insulin. She soon began to lose weight and strength and noted occasional vague pain in the left upper quadrant of the abdomen. The appetite was poor. The nocturia had increased (X 5) but there were no other urinary complaints. One week -before admission the weight loss, weakness, and anorexia had become conspicuous and the left upper quadrant abdominal pain became more pronounced, but without known relation to food intake or respiration. Three days later a daily morning dose of 10 units of insuli

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