| Abscess - Subphrenic
What is it?
You have an abscess which has formed in the upper part of your abdomen just under your chest. This is something brought on by infection after, for example, appendicitis, a burst ulcer, or an operation. The abscess is a pool of half a pint (250ml) or more of liquid pus. It makes you feel ill and feverish. If left, it can get worse, cause serious problems and even, rarely, threaten your life. Commonly these abscesses only show up two or more weeks after the infection. Also they often need to be left even longer than this before they are 'ripe' enough to be opened up and drained safely. The abscess can form high up under the ribs, or deep down in the pelvis, or anywhere in between. Sometimes there are more than one.
You will have a general anaesthetic, and will be asleep for the whole operation. A cut about 3 inches long (8cm) is made in the skin of the tummy as near as possible to the abscess. The cut is deepened until the surgeon reaches the abscess. The pus then drains out to the skin. A rubber drainage tube is put down into the abscess space to drain out any further pus. This tube stays in place until it is clear from X-ray tests that the abscess space is getting smaller. The tube can then be shortened, bit by bit. Finally the wound dries up and heals over.
If you leave things as they are, the abscess may drain out through your skin after many days. You may become very ill and weakened during this waiting time. Sometimes the abscess drains into the lung or spreads around inside your tummy. These can be very serious for you. Antibiotics have not done the trick in your case. Heat treatment and laser treatment will not be helpful. Draining the abscess is all that should be done at this stage. If there is an underlying disease, that needs to be left for later.
Before the operation
You may well be in hospital already, so some of the notes below are only for new comers. Stop smoking and get your weight down if you are overweight. (See Healthy Living.) If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you.
On the ward, you will be checked for past illnesses and will have special tests to prepare you and make sure you can have the operation safely. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special pre-admission clinics, where you visit for an hour or two, a week or so before the operation for these checks.
where you visit for an hour or two, a week or so before the operation for these checks.
After - In Hospital
You will have a drip tube in an arm vein connected to a plastic bag on a stand, containing a salt solution or blood. You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. Swallowing may be a little uncomfortable. You will have a rubber drainage tube coming out of your wound. The tube is connected to a plastic bag. There is a dressing on the wound. You may be given oxygen from a face mask for a few hours if you have had any chest problems in the past. The wound is a little painful. You will be given tablets or injections to control this. Sometimes, the drainage tube tugs painfully on the skin after three or four days. Ask for more painkillers as needed. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help until you can do things for yourself. .
You will be able to get out of bed the day after operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you. You should be able to walk (with the tube and bags) about 25 yards further each day than the day before. Because of the drainage tube (catheter) in the bladder, passing urine should not be a problem. Sometimes there is a feeling that there is a leakage all the time, but this is just an irritation by the tubing and it passes off. Once you can walk about in reasonable comfort, the catheter is taken out. If you cannot pass urine after this catheter is taken out let the nurses know. A little dark red blood, changing to a yellow liquid after a day or two, may ooze around the drain tube. Once the X-ray tests on the drain tube are all right, the tube is taken out inch by inch over several days. This does not hurt. The wound then heals up in five or six days. If there is more discharge for a time, a collecting bag can be stuck onto the skin over the wound. Sometimes the tube needs to stay in place for a week or two, while the abscess space inside your body closes down. You can wash but try to keep the tube and the area of the skin around it dry.. Once the tube is out you can wash or bathe normally. Ordinary soap and water are all you need. Salt water is not needed. You will be given an appointment to visit the outpatient department for a check-up about one month after you leave the hospital. Some hospitals leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rest for a month or more. It may be one to two months before you are back to your normal strength. You can build up your walking by an extra 50 yards each day. At first discomfort in the wound will prevent you from harming yourself by lifting things that are too heavy. After two months, you can lift as much as you could before you had the operation. There is no value in trying to speed the recovery of the wound by special exercises before the months are out. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about three weeks. You can restart sexual relations after three weeks when the wound is comfortable enough. You should be able to go back to a light job after about one month. It may be two months or more before you can return to a heavy job.
Complications can happen because of the original infection. Other abscesses can come to light. The surgeon will talk to you about them. Sometimes the wound drainage goes on and on. Although in most cases the drainage stops and the abscess heals up in the end there is a very small chance that you might need another operation to drain what is left of the abscess. Aches and twinges may be felt in the wound for up to six months.
The operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina - but virtually all patients are back doing their normal duties within three months of leaving hospital. These notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
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