Successful EUS-guided drainage of the abscess in the abdominal cavity consequent to the gastric surgery: Report of a case

EUS-guided drainage has been known to be useful for drainage of pancreatic abscess. Little is described about the drainage for postoperative abscess. We report a successful EUS-guided drainage of the abscess in the abdominal cavity consequent to the gastric surgery. The patient was a 42 years old Japanese female who had been noted to have a submucosal tumor in the stomach close to the gastroesophageal junction. EUS-guided fine needle aspiration was performed and the pathological specimen revealed the GIST (gastrointestinal stromal tumor). Laparoscopic surgery was performed and the submucosal tumor was completely removed. Six days after the surgery the patient developed a high fever and the CT scan revealed an abscess formation in the left subphrenic space. Antibiotic treatment was carried out but the abscess had not been changed in size and the inflammation was not improved. Fourteen days after the surgery, EUS-guided abscess drainage was performed. EG530UT linear EUS scope (Fujifilm, Tokyo) was used. The hypoechoic lesion was recognized closed to the gastric wall, which was measured 7cm in maximal diameter. 19G Echo Tip Ultra endoscopic ultrasound needle (Cook Medical Endoscopy, IN, USA) was used to puncture the lesion, which was followed by the guide wire insertion (0.035 Jagwire, Boston Scientific Japan, Tokyo). Yellowish thick fluid came out from the lesion. Olympus KD-441Q needle knife (Olympus, Tokyo) was inserted over the guide wire and small incision was made. Once the needle knife was removed, a double pigtail tube (PBD-203–0703, Olympus, Tokyo) was inserted over the guide wire and placed into the lesion. Two days after the drainage, the fever had been lowered and the patient could discharge the hospital after seven days of the drainage procedure. Since the abscess became reduced in size, the stent was removed endoscopically after two months of the drainage procedure. The abscess disappeared on the endoscopic examination and the CT scan half a year later. EUS-guided drainage is also a promising procedure for the drainage of the abscess in the abdominal cavity consequent to the gastric surgery.