Transrectal Endoscopic Ultrasound-Guided Drainage of a Tubo-Ovarian Abscess Via a Lumen-Apposing Metal Stent

Abstract

Tubo-ovarian abscess (TOA) is a potentially lethal condition, often requiring a combination of medical and surgical interventions. Endoscopic ultrasound (EUS)-guided drainage is a known modality for safe and effective management of pelvic fluid collections, but its role for the treatment of TOA is not well documented. We report the first known case of successful treatment of a large TOA with EUS-guided transrectal drainage using a lumen-apposing metal stent.

Efficacy of endoscopic ultrasound‐guided abscess drainage for non‐pancreatic abscesses: A retrospective study

“…Therefore, we preferred plastic stents to external catheterization. Alternatively, some reports have shown that metal stents were effective 3,16–18 . For example, Ogura et al showed that EUS‐AD with a metal stent for a liver abscess had a clinical success rate comparable to that achieved with percutaneous drainage (100% vs 89%, P = 0.34) 3 .…”

“…Therefore, decompression can be done rapidly and effectively. Recently, studies have shown that the lumen‐apposing metal stent (LAMS) was effective for treating various abscesses 16–18 . LAMS has bilateral anchor flanges, which can stabilize the stent position and prevent stent dislocation.…”

“…Alternatively, some reports have shown that metal stents were effective. 3 , 16 , 17 , 18 For example, Ogura et al showed that EUS‐AD with a metal stent for a liver abscess had a clinical success rate comparable to that achieved with percutaneous drainage (100% vs 89%, P = 0.34). 3 Metal stents have a larger diameter than plastic stents.…”

“…Recently, studies have shown that the lumen‐apposing metal stent (LAMS) was effective for treating various abscesses. 16 , 17 , 18 LAMS has bilateral anchor flanges, which can stabilize the stent position and prevent stent dislocation. Itoi et al showed that LAMS was effective for treating pancreatic PCs and draining the gallbladder.…”

An Unusual Delayed Complication of Urogynecologic Surgical Mesh: Perirectal Abscess 10 Years After Initial Placement Treated by Endoscopic Removal

“…If, however, there were no fistulous connection that could be used to access the abscess, EUS guidance could be used to locate the abscess cavity and then guide placement of a lumen-apposing metal stent. 9 After placement of the lumen-apposing metal stent, a thinner endoscope could be used to explore the abscess cavity and remove the retained foreign body. EUS-guided drainage of pelvic abscesses has become a very useful technique to approach these collections, which are often deep in the pelvis and in areas that are difficult to access through percutaneous means.…”