Yoshimoto Taiji, Nishimoto Fumiya, Yamamoto Ryuichi, Takenoya Takashi, Takihara Hiroshi
Department of Gastroenterology, Musashino Tokushukai Hospital, Tokyo, Japan.
Department of Gastroenterology, Tokyo-West Tokushukai Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2022 Aug 16;16(2):456-461. doi: 10.1159/000525571. eCollection 2022 May-Aug.
Splenic abscesses are rare, with a reported prevalence of 0.14-0.7% in autopsy studies. The treatment options for splenic abscesses include intravenous antimicrobial therapy, percutaneous drainage, and splenectomy. Although the dissemination of endoscopic ultrasound (EUS) intervention techniques has made it possible to perform puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses where the percutaneous route has been difficult, there have been few reports of EUS-guided drainage of splenic abscesses. A case of a splenic abscess associated with a perforated duodenal ulcer that was successfully treated with EUS-guided transgastric drainage is described. An 89-year-old Asian woman with a perforated duodenal ulcer underwent surgery at another hospital. After surgery, the patient developed a splenic abscess, for which percutaneous treatment was anatomically difficult. Therefore, she was referred to our hospital for treatment of the splenic abscess using EUS-guided drainage. EUS-guided transgastric drainage was performed under sedation using a convex EUS scope. The splenic abscess, measuring approximately 4 × 3 cm, was punctured using a 19-gauge aspiration needle. A 6-Fr pigtail nasocystic drainage tube was placed in the abscess cavity. The procedure was completed without any complications. After EUS-guided drainage, the abscess cavity decreased in size over time, and the patient had a good clinical course and was subsequently discharged. EUS-guided drainage of splenic abscesses may be a safe and effective therapeutic alternative to percutaneous drainage and surgery; however, large-scale investigations are required to confirm the present findings.
脾脓肿较为罕见，尸检研究报告的患病率为0.14 - 0.7%。脾脓肿的治疗选择包括静脉抗菌治疗、经皮引流和脾切除术。尽管内镜超声（EUS）介入技术的普及使得对于经皮途径难以处理的腹腔内脓肿能够通过经胃肠道途径进行穿刺引流，但关于EUS引导下脾脓肿引流的报道很少。本文描述了一例与十二指肠溃疡穿孔相关的脾脓肿，通过EUS引导下经胃引流成功治疗的病例。一名89岁患有十二指肠溃疡穿孔的亚洲女性在另一家医院接受了手术。术后，患者出现脾脓肿，经皮治疗在解剖学上存在困难。因此，她被转诊至我院，采用EUS引导引流治疗脾脓肿。使用凸面EUS内镜在镇静下进行EUS引导下经胃引流。使用19号穿刺针穿刺约4×3 cm的脾脓肿。在脓肿腔内放置一根6Fr猪尾鼻囊肿引流管。该操作顺利完成，无任何并发症。EUS引导下脾脓肿引流可能是经皮引流和手术的一种安全有效的治疗替代方法；然而，需要大规模研究来证实目前的发现。
