Endoscopic ultrasound-guided drainage of an amoebic liver abscess extending into the hepatic subcapsular space

Abstract

Here, we report a case of an amoebic liver abscess (ALA) successfully treated with endoscopic ultrasound (EUS)-guided liver abscess drainage (EUS-LAD). A 37-year-old male with a liver abscess was referred to our hospital due to disease progression despite receiving antibiotic therapy. Computed tomography showed an intrahepatic abscess extending into the hepatic subcapsular space. The abscess could not be punctured through the hepatic parenchyma percutaneously due to the presence of hepatic subcapsular lesions. Hence, EUS-LAD was performed via the transhepatic approach through the stomach. A 5-Fr pigtail-type nasocystic tube was inserted into the abscess through the hepatic parenchyma, with no procedure-related complications. The contents of the abscess had the appearance of anchovy paste which made us suspect an amoebic abscess; therefore, we started antibiotic therapy with metronidazole. Afterwards, serum anti-amoebic antibodies were found to be positive and the diagnosis of ALA was confirmed. Two weeks later, the size of the abscess decreased, and the patient's clinical symptoms disappeared. Hence, the tube was removed. There were no signs of recurrence during the follow-up period. The use of EUS-LAD for pyogenic or tuberculous abscesses has been reported previously. EUS-LAD for an ALA, similar to that for other liver abscesses, is an effective alternative to percutaneous transhepatic abscess drainage or surgical treatment.

Endoscopic ultrasound-guided transgastric drainage of radiologically inaccessible left lobe liver abscess involving segment 4, caudate lobe, and left lateral segments using a modified technique

“…Placement of a 7F NCD alone was successful in draining large abscess (11 × 7 cm) as reported by Seewald et al [1]. Koizumi et al [6] and Yamamoto et al [9] reported success with a 5F NCD. A 10F NCD was used in Cases 2 and 3, as it is equivalent to a standard PCD catheter and allows thick contents to drain.…”

“…However, there is no uniformity in the literature regarding the choice of endoprothesis for transluminal drainage. Double pigtail stents 7F to 10F and/or 5F to 7F NCD were used as endoprostheses in the early reported cases [1][2][3][4][5][6]9]. In all recent publications, the authors have favored fully-covered self-expandable metal stent (FCSEMS) over plastic stents to achieve complete drainage and early abscess resolution [7][8]10].…”

Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses

“…The author concluded that EUS-guided drainage is an effective alternative to PD with some advantages, such as clear visualization, low risk of transcutaneous infection and the possibility of achieving direct access via a transluminal route without an external tube. 20…”

Liver Abscess in Children

“…4 Endoscopic US-guided liver abscess drainage has been described as an effective alternative to open surgery in cases where a hepatic abscess requiring drainage is not accessible percutaneously. 36 Laparoscopy is a minimally invasive option for the treatment of abscesses that cannot be managed medically. Three ports usually provide adequate visualization to deroof the abscess, drain the pus, and irrigate the abscess cavity or abdomen in the event of an extrahepatic collection.…”