Endoscopic Ultrasound-Guided Transrectal Drainage of Perirectal Abscess in a Patient with Crohn Disease

Abstract

Patient: Male, 58-year-old Final Diagnosis: Perirectal abscess Symptoms: Body aches • chills • intermittent pyrexia • myalgias • perirectal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual setting of medical care Background: Crohn disease (CD) is an idiopathic chronic inflammatory disease that can present in the perianal area as perianal CD (pCD), which can present as fistulizing or non-fistulizing. Perirectal abscesses are common complications that are strongly associated with fistula formation. Draining an abscess and not treating the associated fistula leads to a high risk of disease recurrence. An extensive workup is needed to determine the nature and extent of disease and guide the appropriate treatment strategy. Endoscopic ultrasound (EUS) is an important modality for diagnosing CD-associated perianal or perirectal abscesses. It also has been used for treatment as an alternative to conventional surgical and percutaneous drainage techniques because it is minimally invasive and outcomes with it are good. The present report documents the case of a man with a history of CD who was diagnosed with a perirectal abscess that was managed with EUS-guided transrectal drainage. Case Report: A 58-year-old man with a history of CD presented with a 2-week history of chills, body aches, fatigue, and myalgia and a 1-week history of severe perirectal pain with worsening swelling. After a detailed history-taking, physical examination, and diagnostic workup, he was diagnosed with a CD-associated perirectal abscess. The patient and the attending physician decided to proceed with EUS-guided transrectal drainage. Conclusions: Our case provides data regarding use of EUS for treatment of a CD- associated perirectal abscess.

Interventional inflammatory bowel disease: current and future practice

“…Beyond diagnostics, several therapeutic endoscopic procedures have been described for fistula and abscess, including seton placement, fistulotomy, rEUS-guided transmural abscess drainage, mesenchymal stem cell therapy, and defect closure with over the scope clips [43][44][45]. Further research is necessary to determine the appropriateness of these therapies and their position in future practice.…”

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

“…EUS can be used to assist with drainage of pericolonic and perirectal collections. Specifically, it has been employed in Crohn's disease with transrectal collections in scenarios where surgery may be challenging or unnecessary [ 59 ]. First, a needle is introduced with EUS guidance for access and aspiration, followed by guidewire insertion into the abscess cavity.…”

“…First, a needle is introduced with EUS guidance for access and aspiration, followed by guidewire insertion into the abscess cavity. Following this, a balloon catheter can be inserted over the wire for balloon dilation of the tract to allow placement of a pigtail stent to drain the abscess or collection [ 59 ]. Alternatively, one can place EUS guided lumen apposing metal stents (LAMS) for drainage of perirectal or pericolonic abscesses [ 60 ] ( Image 15 ).…”

The use of ultrasound in colonic and perianal diseases

“…Ultrasonography might also play a role in the treatment of perianal abscesses: although surgery and percutaneous drainage are the usual approaches, cases of EUS-guided transrectal drainage have also been reported with good results [ 21 , 22 ].…”