Endoscopic ultrasound-guided transgastric drainage of a splenic abscess: A Case Report

A 75-year-old male presented with abdominal pain and laboratory findings indicative of a bacterial infection. Computed tomography (CT) revealed a subcapsular splenic abscess located in the hilum, measuring 15x15 cm. Due to the location, percutaneous drainage was not carried out, patient had numerous comorbidities and deemed bad surgical candidate. The patient was admitted to our department for endoscopic ultrasound-guided transgastric drainage of the abscess. Subsequently, a Hot Axios 15x10 mm stent was placed through the posterior gastric wall, just below the cardia, to facilitate drainage. Microbiological analysis of the aspirate revealed the presence of ESBL-positive E. coli, which was sensitive to piperacillin/tazobactam, and the patient was treated accordingly. Follow-up CT scans, performed at two and three weeks post-procedure, demonstrated a gradual reduction in the size of the abscess. By the fourth week, the abscess had diminished to a residual 3 cm collection. Concurrently, the patient's inflammatory markers had decreased, and his clinical condition showed significant improvement. Consequently, the stent was removed, and antibiotic therapy was discontinued. The patient was discharged home. Splenic abscess is a rare condition, with potential etiologies including transcatheter arterial embolization or pancreatic tail adenocarcinoma. Endoscopic ultrasound-guided drainage, first described in 2006, is an infrequently used therapeutic approach for splenic abscess and can serve as an alternative to surgery in patients with multiple comorbidities, as illustrated in this case [1].

Publication History

Article published online:
27 March 2025

• References

• 1 Armellini E, Metelli F, Sauta MG, Marini M, Pace F, Patelli G, Nastasi G.. Endoscopic ultrasound-guided drainage of a splenic abscess using lumen-apposing metal stent. Endoscopy 2023; 55 (S 01): E147-E148 Epub 2022 Oct 28