Gastrointest Interv.  2018 Apr;7(1):40-43. 10.18528/gii180006.

Infectious peritonitis after endoscopic ultrasound-guided biliary drainage in a patient with ascites

• Okuno N
• Hara K
• Mizuno N
• Kuwahara T
• Iwaya H
• Tajika M
• Tanaka T
• Ishihara M
• Hirayama Y
• Onishi S
• Toriyama K
• Ito A
• Kuraoka N
• Matsumoto
• Obata M
• Yasuda M
• Kurita Y
• Tanaka H
• Niwa Y

• KMID: 2439205
• DOI: http://doi.org/10.18528/gii180006

Abstract

SUMMARY OF EVENT: Bacterial, mycotic peritonitis and Candida fungemia developed in a patient with moderate ascites who had undergone endoscopic ultrasound-guided biliary drainage (EUS-BD). Antibiotics and antifungal agent were administered and ascites drainage was performed. Although the infection improved, the patient's general condition gradually deteriorated due to aggravation of the primary cancer and he died. TEACHING POINT: This is the first report to describe infectious peritonitis after EUS-BD. Ascites carries the potential risk of severe complications. As such, in patients with ascites, endoscopic retrograde cholangiopancreatography (ERCP) is typically preferred over EUS-BD or percutaneous drainage to prevent bile leakage. However, ERCP may not be possible in some patients with tumor invasion of the duodenum or with surgically altered anatomy. Thus, in patients with ascites who require EUS-BD, we recommend inserting the drainage tube percutaneously and draining the ascites before and after the intervention in order to prevent severe infection.

Keyword

Endoscopic ultrasonography; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided choledochoduodenostomy; Endoscopic ultrasound-guided hepaticogastrostomy; Interventional endoscopic ultrasound

MeSH Terms

Anti-Bacterial Agents
Ascites*
Bile
Candida
Cholangiopancreatography, Endoscopic Retrograde
Drainage*
Duodenum
Endosonography
Fungemia
Humans
Peritonitis*
Anti-Bacterial Agents