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

Splenic abscesses can be a rare complication of pancreatic tail adenocarcinoma [1].

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 lumen-apposing metal stent (LAMS) [5].

A 55-year-old man with a history of locally advanced pancreatic tail cancer developed multiple splenic abscesses after 4 months from diagnosis and three chemotherapy cycles. The initial computed tomography (CT) scan showed spontaneous rupture of the major splenic abscess in the epiploon retrocavity ([Fig. 1]). The patient was referred for EUS evaluation.

Fig. 1 The splenic abscess ruptured in the epiploon retrocavity on computed tomography scan.

On EUS imaging, the abscess was visible from the gastric body and appeared as a hypo-anechoic collection (6 × 8 cm) containing air bubbles with a demarcated wall ([Fig. 2]). SonoVue injection showed no enhancement within the collection, with hyperemia of the abscess wall.

Fig. 2 Endoscopic ultrasound evaluation revealed a hypo-anechoic collection containing air bubbles with a demarcated wall.

EUS-guided aspiration of purulent fluid was performed using a 19-gauge needle for microbiological tests. The fluoroscopic image after contrast injection through the needle confirmed a well-defined cavity ([Fig. 3]). In consideration of signs of anaerobic infection, we performed EUS-guided transgastric drainage using a 10 × 10-mm LAMS over the guidewire ([Video 1]). A large amount of purulent fluid passed into the gastric cavity after LAMS release. The patient recovered quickly from sepsis, and endoscopic evaluation 12 days later showed clearance of the abscess cavity and the LAMS was removed.

Fig. 3 The double cavity of the abscess confirmed by fluoroscopy.

Video 1 Splenic abscess with signs of anaerobic infection treated by endoscopic ultrasound-guided transgastric drainage using a lumen-apposing metal stent.

This case demonstrates the efficacy of an EUS-guided intervention in a complex non-conventional setting. In the hands of an expert endoscopist, EUS-guided drainage of a splenic abscess with a LAMS could be considered on a case-by-case basis as an alternative to percutaneous drainage or surgery.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Su Y, Miao B, Wang H. et al. Splenic abscess caused by Streptococcus gallolyticus subsp. pasteurianus as presentation of a pancreatic cancer. J Clin Microbiol 2013; 51: 4249-4251
• 2 Radcliffe C, Tang Z, Gisriel SD. et al. Splenic abscess in the new millennium: A descriptive, retrospective case series. Open Forum Infect Dis 2022; 9: ofac085
• 3 Lee DH, Cash BD, Womeldorph CM. et al. Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage. Gastrointest Endosc 2006; 64: 631-634
• 4 Okamoto T, Nakamura K, Fukuda K. Endoscopic ultrasound-guided transluminal drainage for aseptic splenic abscess. Endosc Int Open 2021; 9: E1581-E1582
• 5 Elmeligui AM, Deshmukh A, Okasha HH. et al. EUS-guided splenic abscess drainage using lumen apposing metal stent. Endosc Ultrasound 2021; 10: 219-220

Publication History

Article published online:
28 October 2022