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.
| Location | Under the right dome of the diaphragm, above the right lobe of the liver |
|---|---|
| Boundaries |
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| Contents |
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Lets the liver slide under the diaphragm with breathing. Fluid rising through the right paracolic gutter can collect here and form a subphrenic abscess.
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.
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.
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