Dong Lee Article 2

Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage.

Source

Department of Gastroenterology, National Naval Medical Center, Walter Reed Army Medical Center, Uniformed Services University of the Health Services, Bethesda, Maryland, USA.

Abstract

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.

SETTING:

Walter Reed Army Medical Center.

PATIENT:

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.

INTERVENTION:

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.