Endoscopy 2019; 51(04): S235
DOI: 10.1055/s-0039-1681876
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: ERCP ePosters
Georg Thieme Verlag KG Stuttgart · New York

PERCUTANEOUS ENDOSCOPIC ASSISTED HEPATIC ABSCESS DRAINAGE

A Katzarov
1   Gastroenterology, Military Medical Academy Sofia, Sofia, Bulgaria
,
I Popadiin
2   Gastroenterology, Military Medical Academy, Sofia, Bulgaria
,
K Sapundzhiev
2   Gastroenterology, Military Medical Academy, Sofia, Bulgaria
,
Z Dunkov
2   Gastroenterology, Military Medical Academy, Sofia, Bulgaria
,
K Katzarov
2   Gastroenterology, Military Medical Academy, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Duodeno-pancreatic resection is the preferred operative approach in malignant mass lesions of the pancreatic head. One serious long-term complication of the procedure is benign or malignant stenosis of the biliodigestive anastomosis and associated cholangitis.

We present the case of 64-year-old female operated for adenocarcinoma of the pancreatic head. A Whipple procedure was done followed by postoperative chemotherapy. Unfortunately, a year later there was a progression of the disease with mass lesion in the liver hilum and concomitant stenosis of the hepaticojejunal anastomosis. A self-expandable metal stent was placed to relieve the obstructive jaundice and a new cycle of chemotherapy was initiated. Six months later the patient presented in the emergency unit with fever and elevated levels CRP and leukocytes. Upon further ultrasound examination an abscess cavity with solid debris and liquid content was observed in the right liver lobe. The patient was not suitable candidate for surgery and a 10fr drainage catheter was placed percutaneously. However, after few days of continuous lavage with saline and intravenous antibiotics, there were no significant improvement in patient condition.

After multidisciplinary team meeting a decision was made to clear the debris with a gastroscope inserted trough a previously, percutaneously placed self-expandable metal stent. Under ultrasound and fluoroscopy guidance a guidewire was placed in the cavity followed by metal stent insertion. That made possible direct communication between abscess cavity and skin. The lumen of the stent was dilated to 12 mm to facilitate scope passage. The abscess cavity was revealed with a gastroscope and the solid debris were cleared. After the procedure the patient condition improved, and she was discharged from the hospital a few days later.

In our case this innovative technique helped in improving patient condition. It is applicable in selected cases in a tertiary centers with a prepared multidisciplinary team.