Endoscopic ultrasound-guided transluminal drainage for aseptic splenic abscess

Okamoto, Takeshi; Nakamura, Kenji; Fukuda, Katsuyuki

doi:10.1055/a-1529-5969

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…If there is a risk of requiring an intrathoracic route, this clip method can be attempted. Though a linear array echoendoscope (GF-UCT260) was used for the procedure in the present case, some case reports have reported the utility of using a forward-viewing linear echoendoscope for EUS-guided splenic abscess drainage [ 15 , 16 ]. If puncture with a linear array echoendoscope is difficult, use of a forward-viewing linear echoendoscope can also be attempted.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Since the first report of endoscopic ultrasonography (EUS)-guided drainage of pancreatic pseudocysts, this technique has been widely used [ 7 , 8 , 9 , 10 , 11 , 12 ]. Although the development of EUS instruments and techniques has made it possible to perform puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses where the percutaneous route has been difficult, there have been few reports of EUS-guided drainage of splenic abscesses [ 13 , 14 , 15 , 16 ]. A case of a splenic abscess caused by a perforated duodenal ulcer that was successfully treated with EUS-guided transgastric drainage without any complications is reported.…”

Section: Introductionmentioning

confidence: 99%

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Splenic Abscess due to a Perforated Duodenal Ulcer Successfully Treated with Endoscopic Ultrasound-Guided Transgastric Drainage

Yoshimoto

Nishimoto

Yamamoto

et al. 2022

Case Rep Gastroenterol

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Splenic abscesses are rare, with a reported prevalence of 0.14–0.7% in autopsy studies. The treatment options for splenic abscesses include intravenous antimicrobial therapy, percutaneous drainage, and splenectomy. Although the dissemination of endoscopic ultrasound (EUS) intervention techniques has made it possible to perform puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses where the percutaneous route has been difficult, there have been few reports of EUS-guided drainage of splenic abscesses. A case of a splenic abscess associated with a perforated duodenal ulcer that was successfully treated with EUS-guided transgastric drainage is described. An 89-year-old Asian woman with a perforated duodenal ulcer underwent surgery at another hospital. After surgery, the patient developed a splenic abscess, for which percutaneous treatment was anatomically difficult. Therefore, she was referred to our hospital for treatment of the splenic abscess using EUS-guided drainage. EUS-guided transgastric drainage was performed under sedation using a convex EUS scope. The splenic abscess, measuring approximately 4 × 3 cm<sup>2</sup>, was punctured using a 19-gauge aspiration needle. A 6-Fr pigtail nasocystic drainage tube was placed in the abscess cavity. The procedure was completed without any complications. After EUS-guided drainage, the abscess cavity decreased in size over time, and the patient had a good clinical course and was subsequently discharged. EUS-guided drainage of splenic abscesses may be a safe and effective therapeutic alternative to percutaneous drainage and surgery; however, large-scale investigations are required to confirm the present findings.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Splenic Abscess due to a Perforated Duodenal Ulcer Successfully Treated with Endoscopic Ultrasound-Guided Transgastric Drainage

Yoshimoto

Nishimoto

Yamamoto

et al. 2022

Case Rep Gastroenterol

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“…A proposed alternative for treating splenic abscesses is the EUS-guided transgastric drainage of the abscesses: two case reports reported the technique's feasibility in selected patients. None of the patients was treated for splenic abscess following NOM for splenic traumatic injuries; therefore, evidence is poorly generalizable to trauma patients; more evidence is needed to evaluate the role of this technique in the management of splenic abscess [ 166 , 167 ].…”

Section: Methodsmentioning

confidence: 99%

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

et al. 2022

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Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

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“…The management of a splenic abscess includes antimicrobial therapy, percutaneous drainage, and surgery [2]. Since its first description in 2006 [3], a few cases of endoscopic ultrasound (EUS)guided splenic abscess drainage have been reported in the literature [4]. In one case, Nieto et al used a lumenapposing metal stent (LAMS) [5].…”

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confidence: 99%

Endoscopic ultrasound-guided drainage of a splenic abscess using lumen-apposing metal stent

et al. 2022

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Endoscopic ultrasound-guided transluminal drainage for aseptic splenic abscess

Cited by 4 publications

References 5 publications

Splenic Abscess due to a Perforated Duodenal Ulcer Successfully Treated with Endoscopic Ultrasound-Guided Transgastric Drainage

Splenic Abscess due to a Perforated Duodenal Ulcer Successfully Treated with Endoscopic Ultrasound-Guided Transgastric Drainage

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Endoscopic ultrasound-guided drainage of a splenic abscess using lumen-apposing metal stent

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