Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage.
BACKGROUND
Splenic complications of pancreatitis are exceedingly rare, occurring in only 2.2% of cases. Patients typically present in a dramatic fashion and often need an urgent procedure to prevent overwhelming infection or hemorrhage. Historically, the procedures involve surgery (distal pancreatectomy and splenectomy) or percutaneous drainage.


METHODS
Walter Reed Army Medical Center.


METHODS
A patient with acute or chronic pancreatitis presented with pleuritic chest pain and fever up to 105 degrees F (40.6 degrees C). A CT of the abdomen and the pelvis demonstrated a splenic abscess.


METHODS
Because of the technical inability to perform transpapillary drainage, EUS-guided transgastric drainage resolved the splenic abscess.


CONCLUSIONS
This is the first reported case of a splenic abscess treated definitively with endoscopic therapy. In the face of a worsening clinical picture and reported morbidities up to 79% with surgical and percutaneous drainage procedures, endoscopic therapies should be considered in the management of splenic complications of pancreatitis.
Lee
Dong H
DH
Department of Gastroenterology, National Naval Medical Center, Walter Reed Army Medical Center, Uniformed Services University of the Health Services, Bethesda, Maryland, USA.
Cash
Brooks D
BD
Womeldorph
Craig M
CM
Horwhat
John D
JD
D018784:Abdominal Abscess / Q000175:diagnosis / Q000601:surgery*; D002408:Catheters, Indwelling; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000295:instrumentation*; D019160:Endosonography / Q000295:instrumentation*; D020699:Gastroscopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000175:diagnosis; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis; D012008:Recurrence; D013158:Splenic Diseases / Q000175:diagnosis / Q000601:surgery*; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed