Right Subphrenic Space

spatium subphrenicum dextrum

The right subphrenic space lies between the diaphragmatic surface of the right liver lobe and the inferior surface of the right diaphragm. It is bounded medially by the falciform ligament and inferiorly communicates with Morison pouch (right subhepatic space). The right coronary ligament of the liver defines its posterior limit. It is the most common site of subphrenic abscess.

Region: Abdomen

Clinical Relevance

Clinical Notes

Right subphrenic abscess most commonly follows right upper quadrant surgery (cholecystectomy, right colectomy, appendicectomy, liver surgery) or perforated duodenal ulcer. Characteristically it produces right shoulder tip pain from phrenic nerve irritation, fever, ipsilateral basal atelectasis, and reactive right pleural effusion. CT identifies the collection precisely and CT-guided drainage via a subcostal approach (avoiding the pleural space) provides definitive treatment in most cases.

Pathology

Common Injuries & Conditions

Right Subphrenic Abscess After Cholecystectomy

Bile leak from a clipped cystic duct remnant or accessory bile duct after cholecystectomy produces biloma in the subhepatic space that ascends to the right subphrenic space as a biliary abscess, presenting 5-14 days post-operatively with fever and right shoulder pain managed by ERCP sphincterotomy and percutaneous drainage.