Abstract
BackgroundSubdiaphragmatic abscesses are sometimes caused by intraabdominal infections. We report a case of endoscopic ultrasound-guided transgastric drainage.Case presentationA 75-year-old Asian man was referred to our hospital for treatment for upper gastrointestinal bleeding. On admission, blood tests showed a marked inflammatory response, and abdominal computed tomography showed free air in the abdominal cavity and a left subdiaphragmatic abscess. Therefore, the patient was diagnosed with an intraabdominal abscess associated with a perforated duodenal ulcer. Because he did not have generalized peritonitis, fasting and antibiotic treatment were the first therapies. However, because of the strong pressure on the stomach associated with the abscess and difficulty eating, we performed endoscopic ultrasound-guided transgastric drainage. After treatment, the inflammatory response resolved, and food intake was possible. The patient’s condition remains stable.ConclusionsDrainage is the basic treatment for subdiaphragmatic abscesses; however, percutaneous drainage is often anatomically difficult, and surgical drainage is common. We suggest that our success with endoscopic ultrasound-guided transgastric drainage in this patient indicates that this approach can be considered in similar cases and that it can be selected as a minimally invasive treatment method.
Highlights
ConclusionsDrainage is the basic treatment for subdiaphragmatic abscesses; percutaneous drainage is often anatomically difficult, and surgical drainage is common
Causes of subdiaphragmatic abscess include abdominal-surgery-related infections, traumatic abdominal injury, upper gastrointestinal perforation/penetration, and intraabdominal infections, such as hepatic/biliary inflammation [1]
Drainage is the basic treatment for subdiaphragmatic abscesses; percutaneous drainage is often anatomically difficult, and surgical drainage is common
Summary
We experienced a case of subdiaphragmatic abscess associated with a perforated duodenal ulcer that was cured by EUS-guided drainage. Drainage is the basic treatment for subdiaphragmatic abscesses, but percutaneous drainage is often difficult because of the anatomy. EUS-guided transgastric drainage is minimally invasive if the lesion is adjacent to the stomach, and this method is considered safe and effective
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