The left subphrenic space is the peritoneal recess between the left lobe of the liver, the stomach fundus and spleen anteriorly, and the inferior surface of the left diaphragm. It is separated from the right subphrenic space by the falciform ligament and from the lesser sac by the lesser omentum. The left subphrenic space communicates with the left paracolic gutter below the phrenicocolic ligament.
| Location | Under the left dome of the diaphragm, around the left lobe of the liver, stomach fundus and spleen |
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Gives the stomach and spleen room to move with breathing. Abscesses here usually follow splenic or gastric surgery.
Left subphrenic abscess typically follows left upper quadrant surgery (splenectomy, distal pancreatectomy, left colonic surgery, or gastric surgery). It presents with left shoulder tip pain from diaphragmatic irritation, fever, and left basilar atelectasis or pleural effusion on chest radiograph. CT with contrast confirms the collection and its extent, and percutaneous drainage under CT guidance is the first-line treatment. Splenic injury haematoma may dissect into this space.
Post-splenectomy bleeding or pancreatic tail leak from associated splenectomy for distal pancreatectomy produces a left subphrenic collection that becomes infected, causing fever, left shoulder tip pain, and left pleural effusion 5-10 days post-operatively; CT-guided drainage is effective and avoids reoperative morbidity.
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