Endoscopic ultrasound (EUS)-guided pelvic abscess drainage is a minimally invasive
procedure; however, the anatomical challenges and restricted space can lead to complications
[1]. This case report describes the migration of a plastic stent into a pelvic abscess
cavity and its subsequent retrieval using a thin endoscope in a 55-year-old Japanese
man with a pelvic abscess secondary to a hepatic abscess.
One month prior to presentation, the patient underwent EUS-guided pelvic abscess drainage,
during which the commercial plastic stent failed to detach. As an emergency solution,
a self-made plastic stent (Flexima; Boston Scientific, Marlborough, Massachusetts,
United States) was inserted [2]
[3]
[4], which led to improvement of the pelvic abscess ([Fig. 1]). Abdominal computed tomography and radiography performed in preparation for the
removal of the self-made plastic stent revealed that the stent had rotated several
times and lodged within the pelvic abscess cavity ([Fig. 2]). EUS-guided pelvic abscess drainage was used to retrieve the migrated stent ([Video 1]). The residual pelvic abscess cavity and self-made plastic stent were located using
EUS. A 19-G needle was used to puncture the pelvic abscess, followed by placement
of a guidewire into the cavity. The guidewire was left in place as the EUS endoscope
was removed. A standard 9.9-mm endoscope (GIF-H290Z; Olympus, Tokyo, Japan) and an
8-mm dilation balloon were used to enlarge the puncture site. A 5.8-mm thin endoscope
(GIF-1200N; Olympus) was then inserted, providing access to the pelvic abscess cavity
through the dilation tract. Sufficient space and the migrated self-made plastic stent
were identified within the cavity ([Fig. 3]), and the stent was successfully retrieved using a 1.8-mm snare (SD-221L-25; Olympus)
([Fig. 4]).
Fig. 1 Initial endoscopic ultrasound (EUS)-guided pelvic abscess drainage. a Abdominal computed tomography revealed a pelvic abscess secondary to a hepatic abscess
in the retroperitoneum. b EUS-guided pelvic abscess drainage was performed using a convex endoscope (UCT-260;
Olympus, Tokyo, Japan). The abscess was punctured using a 19-G needle. c–d A commercial plastic stent (Piglet; Olympus) could not be released (c); therefore, a self-made plastic stent (Flexima; Boston Scientific, Marlborough,
Massachusetts, United States) was inserted using a direct-view endoscope (GIF-H260;
Olympus) (d). e Radiography revealed improvement in the pelvic abscess.
Fig. 2
a–b Abdominal computed tomography (a) and radiography (b) revealed that the self-made plastic stent had rotated multiple times and lodged
within the pelvic abscess cavity. c Endoscopic ultrasound showed the residual pelvic abscess cavity and migrated self-made
plastic stent (arrows).
Fig. 3 Retrieval of the migrated self-made plastic stent using an endoscopic ultrasound (EUS)-guided
pelvic abscess drainage technique. a After the pelvic abscess was punctured using a 19-G needle, a guidewire was placed
in the abscess cavity using a standard direct-view endoscope (9.9 mm; GIF-H290Z; Olympus,
Tokyo, Japan), and the puncture tract was dilated using an 8-mm balloon. b A thin endoscope (5.8 mm; GIF-1200N; Olympus) was inserted to allow access to the
abscess cavity through the dilation tract. Sufficient space and the migrated self-made
plastic stent were detected within the pelvic abscess cavity. c Radiography revealed the guidewire within the pelvic abscess cavity. d The self-made plastic stent was successfully retrieved using a snare (SD-221L-25;
Olympus).
Fig. 4 Successfully retrieved migrated plastic stent from a 55-year-old Japanese man with
a pelvic abscess secondary to a hepatic abscess who underwent endoscopic ultrasound-guided
pelvic abscess drainage.
Retrieval of a migrated plastic stent from a pelvic abscess using an endoscopic ultrasound-guided
technique in a 55-year-old Japanese man.Video 1
The procedure was completed without complications, and the patient’s progress was
favorable. Our troubleshooting approach, which applied our previously reported technique
[5], proved effective in this case. This highlights the importance of adopting adaptive
strategies for managing unexpected events during interventional EUS procedures, based
on prior experience and knowledge.
Endoscopy_UCTN_Code_CPL_1AK_2AD
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