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

Abstract

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.

Transgastric drainage for subdiaphragmatic abscess secondary to perforation of the sigmoid colon after cytoreductive surgery for advanced ovarian cancer

“…Therefore, we opted for transgastric drainage by endoscopic sonography to minimise the possibility of spreading infection. Some case reports exist in which this technique has been performed for upper gastrointestinal perforation, splenic abscess and complications after pancreatic surgery; all of these cases were minimally invasive and yielded effective therapeutic results 10–14. This procedure consists of puncturing the stomach wall with a needle, inserting a guide wire, dilating the hole with a balloon and then placing a drainage tube.…”

Comparison of endoscopic ultrasound-guided drainage and percutaneous drainage combined with minocycline sclerotherapy for symptomatic hepatic cysts: A retrospective study

“…Asymptomatic SHC does not require treatment, however symptomatic SHC needs to be treated and can be treated using different treatment modalities such as intravenous antibiotic therapy, ultrasound-guided percutaneous catheter drainage (PCD) with sclerotherapy, and surgery. [3][4][5][6][7][8][9] Following publication of the first report on endoscopic ultrasonography (EUS)-guided drainage of pancreatic pseudocysts, this technique has been widely applied in several fields [10][11][12][13] ; however, case reports describing EUS-guided drainage of symptomatic SHC are scarce. [14][15][16][17][18] In addition, there has been no comparison study of EUS-guided drainage and PCD combined with minocycline sclerotherapy.…”