RIGHT SUBDIAPHRAGMATIC ABSCESS FOLLOWING CHOLECYSTECTOMY: A CASE REPORT AND LAPAROSCOPIC MANAGEMENT

Abstract

Subdiaphragmatic abscess is a rare but clinically significant postoperative complication that may occur following laparoscopic cholecystectomy, commonly secondary to retained infected bile or spilled gallstones. Delayed presentation often poses diagnostic and therapeutic challenges because symptoms may be nonspecific and appear months or years after the initial surgery. We report the case of a 74-year-old male who presented with swelling and discomfort in the right hypochondriac region with a previous history of cholecystectomy. Contrast-enhanced computed tomography of the abdomen demonstrated a right-sided subdiaphragmatic lentiform abscess collection measuring 100 × 80 × 15 mm with involvement of the adjacent rectus abdominis muscle and indentation over the hepatic capsule. Additional findings included mild bilateral perinephric fat stranding, small bilateral inguinal hernias, and atheromatous vascular calcifications. Microbiological evaluation of the drained pus showed no bacterial growth, while CBNAAT testing for tuberculosis was negative. Considering the large size and complex anatomical location of the abscess, the patient underwent diagnostic laparoscopy with adhesiolysis, abscess drainage, and extensive peritoneal lavage. The postoperative recovery was uneventful with significant clinical improvement. This case emphasizes the importance of maintaining a high index of suspicion for delayed postoperative intra-abdominal abscesses in patients with previous laparoscopic cholecystectomy. Cross-sectional imaging plays a crucial role in diagnosis and operative planning. Laparoscopic drainage remains a safe and effective minimally invasive therapeutic option for large or anatomically challenging subdiaphragmatic abscesses, offering effective source control with reduced postoperative morbidity.