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Endosc Ultrasound
Endosc Ultrasound
EUSJ
Endoscopic Ultrasound
2303-9027
2226-7190
Lippincott Williams & Wilkins

EUSJ_240060
10.1097/eus.0000000000000059
00011
3
Images and Videos
EUS–guided abscess drainage in an elderly patient with an abscess in the right liver lobe (with video)
Ikeda Yuki ∗
Watanabe Daichi daichi.w.7@gmail.com

Oomori Ginji ginji.oomori@gmail.com

Yamada Shota ardbeg-lover@live.jp

Okuda Toshinori okutokuda@gmail.com

Minami Shinya minami@ojihosp.or.jp

Department of Gastroenterology, Oji General Hospital, Tomakomai, Hokkaido, Japan.
∗ Address for correspondence: Department of Gastroenterology, Oji General Hospital 3-4-8, Wakakusachou, Tomakomai, Hokkaido 053-8506, Japan. E-mail: yu_ikeda86@yahoo.co.jp (Y. Ikeda).
May-Jun 2024
31 5 2024
13 3 198200
28 12 2023
14 3 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing.
2024
Wolters Kluwer on behalf of Scholar Media Publishing.
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OPEN-ACCESSTRUE
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pmcPercutaneous drainage is used as first-line drainage for liver abscesses. However, elderly patients sometimes experience delirium, increasing the risk of tubes being pulled out. Recently, EUS–guided abscess drainage (EUS-AD) is considered an alternative method.[1,2] The right liver lobe is distant from the gastrointestinal wall, making EUS-AD of an abscess in the right lobe challenging.[3]

An 89-year-old woman with a high fever, hypotension, and hypoxemia was referred to our hospital. Computed tomography (CT) revealed multiple abscesses in her right liver lobe [Figure 1A]. Antibiotic therapy, oxygen, and a vasopressor were administered. The patient’s blood pressure and respiration gradually improved; however, an enlarged abscess in the right liver lobe was observed [Figure 1B]. The patient suffered from delirium, and therefore tubes risked being pulled out. An EUS-AD was attempted [Video 1] despite the gastrointestinal wall being distant to the right liver lobe. The liver abscess was visualized with convex EUS and punctured with a 19-gauge needle from the duodenal wall. Blood vessels were avoided by using color Doppler ultrasonography. After detecting pus, a 0.025-inch guidewire (VisiGlide 2; Olympus, Tokyo, Japan) was placed within the abscess [Figure 2]. The fistula was dilated using MTW catheter, and then a 0.035-inch guidewire (RevoWave SeekMaster hard; Piolax Medical Devices, Yokohama, Japan) was replaced. A 7F × 7-cm double-pigtail stent (Advanix J; Boston Scientific, Tokyo, Japan) was deployed into the abscess [Figure 3]. CT 2 weeks later revealed a residual right liver lobe abscess [Figure 4]. As endoscopic reintervention (E-RI), a fully covered self-expandable metallic stent (8 mm × 8 cm, HANAROSTENT Benefit; Boston Scientific) was placed into the abscess after removing the double-pigtail stent [Figure 5]. One week after E-RI, the liver abscess had completely resolved, and the stent was removed under fluoroscopic guidance.

In this case, we described EUS-AD in an elderly patient with an abscess in the right liver lobe that was successfully performed. EUS-AD with internal drainage, which has no risk of self-extraction of tubes compared with external drainage, may be one of the treatment options for elderly patients.

Figure 1 Computed tomography revealed multiple abscesses in the right lobe of the liver (A). The abscess in the right liver lobe was enlarged (B).

Figure 2 The liver abscess was punctured with a 19-gauge needle from the duodenal wall that followed a 0.025-inch guidewire that was placed within the abscess.

Figure 3 A 7F × 7-cm double-pigtail stent was deployed into the abscess.

Figure 4 A residual abscess in the right liver lobe.

Figure 5 A fully covered self-expandable metallic stent was placed into the liver abscess.

Conflicts of Interest

There are no conflicts of interest.

Financial Support and Sponsorship

Nil.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Published online: 31 May 2024
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References

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2 Seewald S Imazu H Omar S , . EUS-guided drainage of hepatic abscess. Gastrointest Endosc 2005;61 :495–498.15758937
3 Yamamoto K Itoi T Tsuchiya T , . EUS-guided drainage of hepatic abscess in the right side of the liver of a patient with Chilaiditi syndrome. VideoGIE 2017;2 :299–300.30027128
