Korean J Gastroenterol.  2017 May;69(5):321-324. 10.4166/kjg.2017.69.5.321.

Isolated Pyogenic Pancreatic Abscess Successfully Treated via Endoscopic Ultrasound-guided Drainage

• Lee JY
• Kim TH
• Chon HK

• KMID: 2383392
• DOI: http://doi.org/10.4166/kjg.2017.69.5.321

Abstract

An isolated pyogenic pancreatic abscess (IPPA) without pancreatitis is extremely rare but can occur in patients with uncontrolled diabetes. This pathologic condition poses a clinical challenge in diagnosis and management because it can be confused easily with a malignancy. Endoscopic ultrasound (EUS) may be a useful diagnostic modality for indeterminate pancreatic lesions and IPPA. Here, we report two cases with elevated carbohydrate antigen 19-9 levels and pancreatic masses on cross sectional imaging. The patients were subsequently diagnosed with IPPA by EUS. EUS-guided drainage was performed successfully and the patients' clinical symptoms and radiologic findings improved. In our experience, EUS and EUS-guided drainage are crucial steps for the diagnosis and management of patients with an indeterminate pancreatic lesion. In addition, EUS-guided drainage has excellent technical and clinical outcomes for the treatment of IPPA.

Keyword

Pancreas; Abscess; Drainage

MeSH Terms

Abscess*
Diagnosis
Drainage*
Humans
Pancreas
Pancreatitis
Ultrasonography

Figure

• 

  Fig. 1 (A) Transverse abdominal CT scans shows an ill-defined low attenuating mass (white arrow) along the pancreatic head. (B) T-2 weighted images demonstrate high signal intensity (black arrow) in the central portion of the mass. (C) A 20-G FNA needle (white arrow) entering the ill-defined low echoic lesion for aspiration is visible. (D) Yellowish pus discharge from the aspiration fluid collected by EUS-FNA. (E) Fluoroscopic view, demonstrating a naso-abscess catheter (5 Fr) placed into the abscess cavity through the duodenal wall. (F) Follow-up CT shows the resolution of an isolated pyogenic pancreatic abscess. CT, computed tomography; FNA, fine needle aspiration; EUS, endoscopic ultrasound.

• 

  Fig. 2 (A) Non-contrast enhanced abdominal CT showing an exophytic mass in the uncinate process of the pancreas. (B) On EUS, a heterogeneous low echoic lesion with floating echogenic materials (white arrow) is visible. (C) EUS image of the 2nd abscess drainage using a 22 gauge needle in the remaining abscess cavity. (D) After 3 months, abdominal CT shows the resolved state of the exophytic pancreatic mass. CT, computed tomography; EUS, endoscopic ultrasound.

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