Ahmed M. Elmeligui, MBBCh, MD1, Ameya A. Deshmukh, BA2, Javier Tejedor-Tejada, MD3, Enad Dawod, MD4, Jose Nieto, DO, FACG5; 1Kasr Alainy Hospital / Cairo University, Cairo, Al Jizah, Egypt; 2Midwestern University - CCOM, Downers Grove, IL; 3Hospital Universitario Rio Hortega, Valladolid, Castilla y Leon, Spain; 4New York-Presbyterian/Weill Cornell Medical Center, New York City, NY; 5Borland Groover Clinic, Jacksonville, FL
Introduction: Splenic abscess is an uncommon clinical infection with an estimated incidence of 0.5%. Hematogenous spread from another infected area in the body is the most common source of splenic abscess. While in some cases, a pancreatic abscess and diverticulitis may sometimes 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 less than 1% with proper treatment. EUS-guided drainage of splenic abscess using lumen apposing metal stent (LAMS) is an emerging alternative novel procedure appropriate for patients who cannot tolerate surgery.
Methods: A 44-year-old male presented with a syncopal episode with a past medical history significant for hypertension and necrotizing pancreatitis. During a prior admission for abdominal pain 3 months ago, he developed pancreatic necrosis during an ERCP and subsequently underwent pseudocyst drainage. He continued to experience similar abdominal pain from this previous admission. CT of the abdomen revealed a gastric drainage catheter extending into a complex splenic collection with soft tissue stranding and fluid tracking throughout the abdomen. A cystogastrostomy approach for abscess drainage was chosen due to the close proximity of the stomach wall and abscess. A 10 x 10 mm LAMS was utilized due to the large size of the abscess and to avoid buried stent syndrome that can occur with double pigtail stents. First, the endoscope was advanced into the stomach and the splenic abscess was visualized. Then, under EUS-guidance, one 10 x 10 mm LAMS was deployed with cautery enhancement into the abscess cavity through the stomach wall. Once deployment of the LAMS was complete, the pyogenic contents were drained into the stomach. Follow up CT scan was performed one-month post procedure and revealed complete splenic abscess resolution. Discussion: EUS-guided splenic abscess drainage is a safe and 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 clinical practice, EUS-guided splenic drainage is shown to have a higher success rate with fewer complications compared to percutaneous drainage and surgery. EUS-guided drainage has also been successfully performed on other conditions involving pancreatic pseudocysts, hepatic abscesses, pelvic abscesses, and subphrenic abscesses.
EUS visualization of the splenic abscess measuring 5.9 cm x 6.9 cm.
EUS visualization of the distal flange of LAMS deployment into the abscess cavity.
CT scan displaying complete drainage of the splenic abscess after LAMS deployment.
Disclosures: Ahmed Elmeligui indicated no relevant financial relationships. Ameya Deshmukh indicated no relevant financial relationships. Javier Tejedor-Tejada indicated no relevant financial relationships. Enad Dawod indicated no relevant financial relationships. Jose Nieto: Boston Scientific – Consultant. ERBE – Consultant.