Endoscopy 2023; 55(S 02): S350
DOI: 10.1055/s-0043-1766007
Abstracts | ESGE Days 2023
ePoster

Spontaneous rupture of a subphrenic abscess after splenectomy into the stomach: successful treatment with endoscopic vacuum therapy

Authors

  • E. Mavropoulou

    1   Vivantes Clinic in Friedrichshain, Berlin, Germany

  • M. Zweimueller

    1   Vivantes Clinic in Friedrichshain, Berlin, Germany

  • K. Peymann

    1   Vivantes Clinic in Friedrichshain, Berlin, Germany

  • J. Hochberger

    1   Vivantes Clinic in Friedrichshain, Berlin, Germany

  • T. Brunk

    1   Vivantes Clinic in Friedrichshain, Berlin, Germany
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Aims We present a rare case of a ruptured subphrenic abscess into the stomach after an emergency splenectomy that was successfully treated with endoscopic vacuum therapy.

Methods A 71-year-old male presented in the emergency department with hypovolemic shock. The abdominal computed tomography (CT) showed an acute rupture of the spleen with active bleeding and haemoperitoneum. An emergency splenectomy was performed. On the 11th postoperative day a subphrenic abscess was diagnosed and a CT-guided percutaneous drainage was placed. After the injection of contrast agent via the catheter a spontaneous drainage of the abscess into the stomach was detected.

Results In the upper endoscopy the perforation site was located at the great curvature of the body. Closure of the defect with an over-the-scope clip device (OTSC System, Ovesco Endoscopy, Germany) was unsuccessful due to the inflammation of the mucosal edges. Therefore, a 13 mm Eso-SPONGE (B. Braun Medical, Melsungen, Germany) was placed in the cavity over the plastic tube. The sponge was connected to the suction bottle with a negative pressure of -125 mmHg. After 48 hours a new vacuum sponge was replaced. At day 5 the cavity was completely retracted and covered with granulation tissue. The sponge was removed and four 10-French transgastric double pigtail stents were placed.

Conclusions Six weeks later a complete resolution of the abscess and epithelialisation of the defect in the stomach after spontaneous passage of the stents was achieved.


Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023

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