Clin Endosc.  2019 Jul;52(4):373-376. 10.5946/ce.2018.134.

Endoscopic Ultrasound-Guided Transgastric Drainage of an Intra-Abdominal Abscess following Gastrectomy

• Kikuchi S
• Kubota T
• Kuroda S
• Nishizaki
• Kagawa S
• Kato H
• Okada H
• Fujiwara T

• KMID: 2455636
• DOI: http://doi.org/10.5946/ce.2018.134

Abstract

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.

Keyword

Endoscopic ultrasound; Postoperative intra-abdominal abscess; Transgastric drainage

MeSH Terms

Abdominal Abscess*
Abscess
Anastomotic Leak
Drainage*
Gastrectomy*
Humans
Needles
Pancreatic Fistula
Punctures
Stomach Neoplasms
Ultrasonography

Figure

• 

  Fig. 1. Imaging findings in Case 1 show the following features: (A) Computed tomography (CT) scan shows an intra-abdominal abscess around the remnant stomach (arrowheads). (B) Endoscopic ultrasound (EUS) image shows a small cloudy fluid collection around the stomach (arrowheads). (C) Endoscopic examination shows red, bulging mucosa on the posterior wall of the remnant stomach. (D) One month after the EUS-guided drainage, the CT scan shows no fluid collection around the stomach.

• 

  Fig. 2. Imaging findings in Case 2 show the following features: (A, B) Computed tomography scan shows a swelling of the body of the pancreas and a fluid collection around the remnant stomach (arrowheads). (C) Endoscopic ultrasound image shows a huge unilocular cyst close to the remnant stomach, which was punctured using a needle. (D) A fluoroscopic image shows the placement of a 7-Fr pigtail nasal biliary catheter. (E) An angiographic image shows that the bleeding from a pseudoaneurysm of the common hepatic artery has been successfully treated with coil embolization.

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