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 Table of Contents  
IMAGES AND VIDEOS
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 219-220

EUS-guided splenic abscess drainage using lumen apposing metal stent


1 Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
2 Department of Internal Medicine, Midwestern University – CCOM, Downers Grove, IL, USA
3 Division of Gastroenterology, Hepatology and Endoscopy, University of Missouri School of Medicine, Columbia MO, USA
4 Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
5 Division of Gastroenterology, Hepatology and Endoscopy, Borland Groover Clinic, Jacksonville, FL, USA

Date of Submission23-Dec-2020
Date of Acceptance01-Mar-2021
Date of Web Publication06-May-2021

Correspondence Address:
Prof. Hussein Hassan Okasha
Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EUS-D-20-00262

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How to cite this article:
Elmeligui AM, Deshmukh A, Okasha HH, Parsa N, Tejedor-Tejada J, Nieto J. EUS-guided splenic abscess drainage using lumen apposing metal stent. Endosc Ultrasound 2021;10:219-20

How to cite this URL:
Elmeligui AM, Deshmukh A, Okasha HH, Parsa N, Tejedor-Tejada J, Nieto J. EUS-guided splenic abscess drainage using lumen apposing metal stent. Endosc Ultrasound [serial online] 2021 [cited 2021 Jul 24];10:219-20. Available from: http://www.eusjournal.com/text.asp?2021/10/3/219/315514

A 44-year-old male presented with abdominal pain and fever. He experienced an attack of post endoscopic retrograde cholangiopancreatography necrotizing pancreatitis with pancreatic fluid collection that was drained by percutaneous approach with significant improvement of his condition and the inserted 12 F pig-tail catheter was removed after 3 weeks. Two months later, he experienced similar abdominal pain, computed tomography (CT) of the abdomen revealed complex splenic collection with soft-tissue stranding and fluid tracking throughout the abdomen.

A cystogastrostomy approach for abscess drainage was chosen due to its close proximity to the gastric wall. In addition, the large size of the abscess made it suitable and convenient to use lumen apposing metal stent, 10 mm × 10 mm (Axios, Boston Scientific TM), instead of using double pig-tail stent for more proper draining. First, the echo-endoscope was advanced into the stomach and the splenic abscess was visualized [Figure 1]. Then, under endoscopic ultrasound (EUS)-guidance, one 10 mm × 10 mm lumen-apposing metal stent (LAMS) was deployed with cautery enhancement into the abscess cavity through the gastric wall [Figure 2]. Once deployment of the LAMS was complete, the pyogenic contents were drained into the stomach [Figure 3]. Follow-up CT scan was performed 1-month post procedure and revealed complete splenic abscess resolution [Figure 4].
Figure 1: EUS view of the abscess, measuring 5.9 cm × 6.9 cm

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Figure 2: Echoendoscopic view of the distal flange of lumen-apposing metal stent deployment into abscess cavity. Deployment of distal end of the 10 × 10 mm LAMS

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Figure 3: Endoscopic view of the proximal flange of lumen-apposing metal stent deployment into the gastric lumen

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Figure 4: Computed tomography scan showing resolution of the splenic abscess post lumen apposing metal stent placement with the Axios stent in place. Complete splenic abscess drainage after LAMS deployment

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Splenic abscess is an uncommon clinical infection with an estimated incidence of 0.05%–0.7%.[1] In some cases, a pancreatic abscess and diverticulitis may extend and involve the spleen. The diagnosis of this condition can be easily missed resulting in a very high mortality reaching more than 70%. Nevertheless, the mortality can be reduced to <1% with proper treatment.[2],[3],[4] EUS-guided drainage of splenic abscess using LAMS is an emerging alternative novel procedure appropriate for patients who cannot tolerate surgery. It is a safe and more effective therapeutic alternative to CT-guided percutaneous drainage and surgery. It allows for greater spatial visualization and awareness of anatomical structures aiding in the placement of stents. In conclusion, EUS-guided splenic abscess drainage is an emerging procedure that may have a higher success rate with fewer complications compared to percutaneous drainage and surgery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Westh H, Reines E, Skibsted L, et al. Splenic abscesses: A review of 20 cases. Scand J Infect Dis 1990;22:569-73.  Back to cited text no. 1
    
2.
Lee MC, Lee CM. Splenic abscess: An uncommon entity with potentially life-threatening evolution. Can J Infect Dis Med Microbiol 2018;2018:8610657.  Back to cited text no. 2
    
3.
Sahu M, Kumar A, Nischal N, et al. Splenic abscess caused by salmonella typhi and co-infection with leptospira. J Assoc Physicians India 2017;65:95-7.  Back to cited text no. 3
    
4.
Chen H, Hu ZQ, Fang Y, et al. A case report: Splenic abscess caused by Burkholderia pseudomallei. Medicine (Baltimore) 2018;97:e11208.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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