2127 Splenic Abscess Management With a Lumen Apposing Metal Stent: Case Report

Abstract

INTRODUCTION: Splenic abscess is an uncommon infection (incidence 0.5%) that if left untreated, could be fatal. The most common source of splenic abscesses is usually hematogenous spread from an infected source from another part of the body. The patient typically presents with fever, left upper quadrant pain, and/or splenomegaly. CT scan is the imaging modality of choice for diagnosing splenic abscess. Management of splenic abscess consists of antibiotic treatment and splenectomy. The use of percutaneous CT-guided drainage is a safer spleen-conserving alternative to surgery. In this case report , we describe novel approach, to treat splenic abscess via endoscopic ultrasound-guided (EUS) placement of a lumen apposing metal stent (AXIOS). CASE DESCRIPTION/METHODS: This is a 44 year old male with a past medical history significant for necrotizing pancreatitis and gastric varicies who presented to our center with fever and weakness. He was previously admitted 3 months prior with post ERCP necrotizing pancreatitis which was managed successfully with endoscopic therapy. The patient reported that on the day of admission, he developed a low-grade fever and lethargy. The abdomen was soft, mildly distended, with tenderness to palpation in the left and right lower quadrants. CT of the abdomen revealed a formation of a splenic abscess measuring 5 cm × 6.5 cm. Blood cultures were positive for ESBL and the patient was started on antibiotics. An EUS was performed that showed a splenic abscess and an abscessgastrostomy was successfully performed using a 10 × 10 mm lumen-apposing metal stent (LAMS). One week later a repeat EGD with debrivement and lavage of the abscess cavity was performed and a 10 F × 5 cm double pigtail stent was exchanged for the LAMS. On month later, a CT scan showed complete splenic abscess resolution and the double pigtail was removed. Six month CT scan showed no abscess recurrence. DISCUSSION: EUS has been described in the drainage of pelvic, mediastinal and intrabdominal abcess. In this report we describe the first use of lumen apposing metal stent for endoscopic management of a splenic abscesses. Lee et al first reported the use of EUS guided splenic abscess drainage with the use of a double pigtail stent. This approach showed to be safe and less invasive alternative to the standard of care. In cases of worsening clinical status and reported morbidities as high as 79% with surgical and percutaneous drainage procedures, endoscopic therapies should be considered in the management of splenic abscess.