Endoscopic ultrasound-guided retrieval of a migrated plastic stent from a pelvic abscess

Endoscopic ultrasound (EUS)-guided pelvic abscess drainage is a minimally invasive procedure; however, the anatomical challenges and restricted space can lead to complications [1]. This case report describes the migration of a plastic stent into a pelvic abscess cavity and its subsequent retrieval using a thin endoscope in a 55-year-old Japanese man with a pelvic abscess secondary to a hepatic abscess.

One month prior to presentation, the patient underwent EUS-guided pelvic abscess drainage, during which the commercial plastic stent failed to detach. As an emergency solution, a self-made plastic stent (Flexima; Boston Scientific, Marlborough, Massachusetts, United States) was inserted [2] [3] [4], which led to improvement of the pelvic abscess ([Fig. 1]). Abdominal computed tomography and radiography performed in preparation for the removal of the self-made plastic stent revealed that the stent had rotated several times and lodged within the pelvic abscess cavity ([Fig. 2]). EUS-guided pelvic abscess drainage was used to retrieve the migrated stent ([Video 1]). The residual pelvic abscess cavity and self-made plastic stent were located using EUS. A 19-G needle was used to puncture the pelvic abscess, followed by placement of a guidewire into the cavity. The guidewire was left in place as the EUS endoscope was removed. A standard 9.9-mm endoscope (GIF-H290Z; Olympus, Tokyo, Japan) and an 8-mm dilation balloon were used to enlarge the puncture site. A 5.8-mm thin endoscope (GIF-1200N; Olympus) was then inserted, providing access to the pelvic abscess cavity through the dilation tract. Sufficient space and the migrated self-made plastic stent were identified within the cavity ([Fig. 3]), and the stent was successfully retrieved using a 1.8-mm snare (SD-221L-25; Olympus) ([Fig. 4]).

Fig. 1 Initial endoscopic ultrasound (EUS)-guided pelvic abscess drainage. a Abdominal computed tomography revealed a pelvic abscess secondary to a hepatic abscess in the retroperitoneum. b EUS-guided pelvic abscess drainage was performed using a convex endoscope (UCT-260; Olympus, Tokyo, Japan). The abscess was punctured using a 19-G needle. c–d A commercial plastic stent (Piglet; Olympus) could not be released (c); therefore, a self-made plastic stent (Flexima; Boston Scientific, Marlborough, Massachusetts, United States) was inserted using a direct-view endoscope (GIF-H260; Olympus) (d). e Radiography revealed improvement in the pelvic abscess.

Fig. 2 a–b Abdominal computed tomography (a) and radiography (b) revealed that the self-made plastic stent had rotated multiple times and lodged within the pelvic abscess cavity. c Endoscopic ultrasound showed the residual pelvic abscess cavity and migrated self-made plastic stent (arrows).

Fig. 3 Retrieval of the migrated self-made plastic stent using an endoscopic ultrasound (EUS)-guided pelvic abscess drainage technique. a After the pelvic abscess was punctured using a 19-G needle, a guidewire was placed in the abscess cavity using a standard direct-view endoscope (9.9 mm; GIF-H290Z; Olympus, Tokyo, Japan), and the puncture tract was dilated using an 8-mm balloon. b A thin endoscope (5.8 mm; GIF-1200N; Olympus) was inserted to allow access to the abscess cavity through the dilation tract. Sufficient space and the migrated self-made plastic stent were detected within the pelvic abscess cavity. c Radiography revealed the guidewire within the pelvic abscess cavity. d The self-made plastic stent was successfully retrieved using a snare (SD-221L-25; Olympus).

Fig. 4 Successfully retrieved migrated plastic stent from a 55-year-old Japanese man with a pelvic abscess secondary to a hepatic abscess who underwent endoscopic ultrasound-guided pelvic abscess drainage.

Retrieval of a migrated plastic stent from a pelvic abscess using an endoscopic ultrasound-guided technique in a 55-year-old Japanese man.Video 1

The procedure was completed without complications, and the patient’s progress was favorable. Our troubleshooting approach, which applied our previously reported technique [5], proved effective in this case. This highlights the importance of adopting adaptive strategies for managing unexpected events during interventional EUS procedures, based on prior experience and knowledge.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Soga K, Sai A, Kitae H. Efficacy of endoscopic ultrasound-guided pelvic abscess drainage for pelvic abscesses: a case series study. Arab J Gastroenterol 2023; 24: 149-154
• 2 Soga K. Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series. Clin Endosc 2024; 57: 263-267
• 3 Soga K. Usefulness of inserting a modified single-pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage. Endoscopy 2023; 55: E1081-E1082
• 4 Soga K, Mukai H, Kitae H. Management of afferent loop obstruction using multiple single-pigtail plastic stents in a patient with recurrent metastatic pancreatic cancer. Endoscopy 2022; 54: E1041-E1042
• 5 Soga K, Kitae H. Troubleshooting the migration of a double-pigtail plastic stent into a pelvic abscess (with videos). Endosc Ultrasound 2023; 12: 303-304

Publication History

Article published online:
14 October 2024