Elias Estifan, MD
Post Graduate Resident
St. Jospeh's University Medical Center
Paterson, New Jersey
Abdalla Mohamed, MD, Yana Cavanagh, MD, Elias Estifan, MD, Matthew Grossman, MD
St. Joseph's University Medical Center, Paterson, NJ
Introduction: Pelvic abscesses can occur as sequelae of surgery and are associated with significant morbidity and mortality. The treatment of choice for these abscesses is immediate initiation of broad-spectrum antibiotics and drainage of the collection. We propose that lumen-apposing self-expanding metal stents (LAMS) are a safe treatment option for drainage of pelvic abscesses. LAMS were originally designed for transmural pancreatic fluid collection drainage however have been successfully used for drainage of various extra-luminal fluid collections.
Case Description/Methods: The patient is an obese 34-year-old female with a PMHx of IDDM, and HTN who had recently underwent ex-lap for a large non-malignant pelvic mass. On POD #5, the patient developed a fever and repeat CT revealed a multiloculated pelvic abscess measuring 5.8 x 4.2 cm. IR was unable to drain the collection in this location between bladder and rectum. Rectal EUS was performed and revealed a septated fluid collection viewed best using 7.5mHz ultrasound at 10cm from the anal verge. A 2cm margin was observed between the abscess and the urinary bladder. A 2mm margin was seen between the rectal wall and the abscess wall. A 19-gauge non-core needle was used to access the fluid collection which appeared purulent. A 15mm AXIOS stent was then deployed using the same technique employed with pseudocyst drainage. Drainage was successful. 9 days after placement, the stent was removed using a cold snare. No bleeding resulted from stent pull. The defect was then clipped closed with a 15mm over the scope clip. The patient tolerated the procedure well, experienced complete resolution of the abscess.
Discussion: Manvar et al suggest that EUS-guided LAMS drainage of pelvic abscesses is more efficacious and has a more favorable safety profile when compared to EUS-guided drainage with catheters and plastic stents. It is an efficient and safe alternative for the management of intra-abdominal and pelvic collections. This case demonstrated the novel use of a lumen-apposing self-expanding metal stent for peri-rectal abscess drainage. Although more evidence is needed for its off-label use, we conclude that it should be strongly considered as a viable treatment option if not the initial treatment modality for collections located in the pelvis.
Citation: Abdalla Mohamed, MD, Yana Cavanagh, MD, Elias Estifan, MD, Matthew Grossman, MD. P0590 - PERIVESICULAR ABSCESS DRAINAGE WITH AXIOS STENT. Program No. P0590. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.