Mark Crislip, MD, Infectious Diseases, 11:40PM Sep 16, 2013
The patient had a cecum resection that had an anastomotic leak. The leak was repaired, but she represented with RUQ pain, fever, and leukocytosis.
A CT shows a large abscess between the diaphragm and the liver. It is drained and grows colon bugs. The microbiology is no surprise. But why the abscess so far from the original insult?
Curtis and Fitz-Hugh noted the propensity for Gonorrhea to travel from the fallopian tubes all the way to perihepatic space. Their original descriptions make for interesting reading.
Supposedly respiration leads to a negative pressure in the the RUQ and infection and mets are sucked into the area. The RUQ has the lowest pressure and sucks the most.
I found multiple statements to the effect that
But I can't find the original measurements and papers that demonstrate the RUQ slurping up infectious material. Maybe my Google-fu is off. Or maybe it is as Stephen Jay Gould said.
"No scientific falsehood is more difficult to expunge than textbook dogma endlessly repeated in tabular epitome without the original data."
So if the RUQ truly sucks I can't find the proof. I am sure someone will set me straight.
Am Surg. 2001 Mar;67(3):243-8. What is normal intra-abdominal pressure?
A CAUSE OF ADHESIONS IN THE RIGHT UPPER QUADRANT ARTHUR H. CURTIS, M.D. JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.
ACUTE GONOCOCCIC PERITONITIS OF THE RIGHT UPPER QUADRANT IN WOMEN THOMAS FITZ-HUGH Jr., M.D. JAMA.1934;102(25):2094-2096. doi:10.1001/jama.1934.02750250020010.
Patterns of peritoneal spread of tumor in the abdomen and pelvis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650201/