EUS-guided transgastric drainage of splenic abscess: a case-series

Aims Splenic abscesses are rare, with an estimated incidence of 0.05%–0.7%. The treatment options for splenic abscesses include intravenous antimicrobial therapy, percutaneous drainage, and splenectomy. Recent studies have shown that endoscopic ultrasound (EUS)-guided abscess drainage could effectively treat various abscesses and fluid collections. However, there have been few reports of EUS-guided drainage of splenic abscesses. We present a series of 3 patients who underwent EUS-guided transgastric drainage of the splenic abscess.

Methods A retrospective search in our databases was conducted until June 2024. The primary endpoint was to assess the technical success of EUS-guided drainage of the splenic abscess, followed by clinical success, and adverse events related to the procedure.

Results Three cases were reviewed. Case 1: An 81-year-old female developed a splenic abscess 3 weeks after EUS-FNA for residual splenic mass following systemic chemotherapy for diffuse large B-cell lymphoma. An abdominal CT showed a splenic mass (8.1 cm×6.2 cm). Case 2: A 66-year-old male developed a splenic abscess 1 month after neoadjuvant chemotherapy for pancreas tail cancer. The CT revealed a splenic mass (6.1×4.0 cm). Case 3: An 84-year-old male receiving hemodialysis with liver cirrhosis presented with abdominal pain and fever. The CT demonstrated a splenic mass (9.6×7.7 cm). EUS-guided transgastric drainage was performed using a 19-gauge aspiration needle in all patients. A 6-Fr pigtail nasocystic drainage (NCD) tube was placed in the abscess cavity in Case 1, a 6-Fr pigtail NCD tube and 7-Fr double pigtail plastic stent (DPPS) in Case 2, and a 7-Fr double DPPS in Case 3. Two complications occurred in Case 1 and Case 3. Case 1 developed intraabdominal fluid collections, and EUS-guided drainage was performed. Case 3 experienced mild intraabdominal bleeding, which was resolved by conservative management. After EUS-guided drainage of splenic abscesses, the abscess cavity decreased in size over time, and all patients had a good clinical course and were subsequently discharged. In Case 3, recurrence due to clogged DPPS was observed 4 months after EUS-guided drainage, which was resolved by replacement.

Conclusions EUS-guided drainage of splenic abscesses may be a safe and effective therapeutic alternative to percutaneous drainage and surgery.

Publication History

Article published online:
27 March 2025