Post written by Ignacio Fernández-Urién, MD, PhD, from the Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain.
We presented the case of a 50-year-old woman with an 8-cm pelvic abscess secondary to an acute diverticulitis that was drained guided by EUS. First, we punctured the lesion with a 19-gauge needle, and 5 mL of purulent material was obtained and sent for culture. Then, an 8-mm × 8-mm LAMS (Hot Axios; Boston Scientific, Marlborough, Mass, USA) was deployed, and complete resolution of the abscess was achieved 3 weeks later.
The approach to those collections located at the pelvic area is usually percutaneous and guided by ultrasonography or CT scan. However, they may present a clinical challenge for physicians because their location is usually surrounded by the pelvis, urinary bladder, rectum, prostate, vagina and/or uterus. On the other hand, depending on the selected route, some patients may experience pain and discomfort at the puncture site. This is more frequent with the transvaginal approach but can also happen with the transabdominal and transgluteal approaches.
EUS-guided drainage of pelvic collections offers the possibility of using a trans-rectal approach which has 3 important advantages compared to percutaneous approaches: I) pelvic collections are often close to the rectum, so there are no organs between collections and the echoendoscope; II) trans-rectal stents are not painful or uncomfortable; III) trans-rectal approach allows us to deploy stents with greater diameters than percutaneous catheters resulting in a more efficient and faster resolution of lesions. Despite its advantages, only a few cases of LAMS in pelvic lesions have been previously published.
EUS-guided drainage of pelvic abscesses and/or collections is simple, efficient, and safe for patients. In our opinion, EUS-guided drainage should be taken into account as a first-line therapeutic option in this clinical scenario.
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