Endoscopic ultrasound-guided transmural drainage for subphrenic abscess: report of two cases and a literature review

Abstract

BackgroundAn intra-abdominal abscess can sometimes become serious and difficult to treat. The current standard treatment strategy for intra-abdominal abscess is percutaneous imaging-guided drainage. However, in cases of subphrenic abscess, it is important to avoid passing the drainage route through the thoracic cavity, as this can lead to respiratory complications. The spread of intervention techniques involving endoscopic ultrasonography (EUS) has made it possible to perform drainage via the transmural route.Case presentationWe describe two cases of subphrenic abscess that occurred after intra-abdominal surgery. Both were treated successfully by EUS-guided transmural drainage (EUS-TD) without severe complications. Our experience of these cases and a review of the literature suggest that the drainage catheters should be placed both internally and externally together into the abscess cavity. In previous cases there were no adverse events except for one case of mediastinitis and pneumothorax resulting from transesophageal drainage. Therefore, we consider that the transesophageal route should be avoided if possible.ConclusionsAlthough further studies are necessary, our present two cases and a literature review suggest that EUS-TD is feasible and effective for subphrenic abscess, and not inferior to other treatments. We anticipate that this report will be of help to physicians when considering the drainage procedure for this condition. As there have been no comparative studies to date, a prospective study involving a large number of patients will be necessary to determine the therapeutic options for such cases.

Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient

“…[5][6][7] In the subphrenic location, the percutaneous approach continues to be the method of choice, but it is known that those collections can be near the lungs, pleura, liver, and intestines, which can affect visualization or make drainage risky. 3,8,9 In this context, the use of minimally invasive methods, such as EUS, can be of diagnostic value in determining the cause, as well as being therapeutic through puncture and aspiration. We found no cases of EUS-guided puncture and drainage of adrenal abscesses in our review of the literature.…”

“…Regarding adrenal gland infections, simple percutaneous drainage through aspiration, especially in pediatric populations, has been described with good clinical results in case reports [ 5 - 7 ]. In the subphrenic location, the percutaneous approach continues to be the method of choice, but it is known that those collections can be near the lungs, pleura, liver, and intestines, which can affect visualization or make drainage risky [ 3 , 8 , 9 ]. In this context, the use of minimally invasive methods, such as EUS, can be of diagnostic value in determining the cause, as well as being therapeutic through puncture and aspiration.…”

Percutaneous drainage under the control of ultrasound of the left-sided subphrenic abscess after gastrectomy: A case report

“…It should be noted that the average bed-day with percutaneous drainage of subphrenic abscesses without fistula is 13.2 days [1,14].…”

“…Today, an effective treatment for LSA is its puncture and drainage under the control of ultrasound and X-ray. The effectiveness of this method ranges from 60 to 92% [[1], [2], [3]]. However, this method does not always allow to cure a patient with a large abscess that has a connection with hollow organs or ductal structures: in 33% of cases this fistula does not heal on its own and requires surgical intervention [4,5].…”

Endoscopic ultrasound-guided transluminal drainage for aseptic splenic abscess

“…No recurrence was observed during 12 months of follow-up. There have recently been several reports of successful EUS-TD for subphrenic abscesses, including one report of EUS-TD for a splenic abscess that arose as a complication of acute pancreatitis [4,5]. EUS-TD may be an attractive option for splenic abscesses because they are often difficult to access percutaneously and are frequently refractory to medical treatment alone.…”