Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage

BackgroundSplenic complications of pancreatitis are exceedingly rare, occurring in only 2.2% of cases. Patients typically present in a dramatic fashion and often need an urgent procedure to prevent overwhelming infection or hemorrhage. Historically, the procedures involve surgery (distal pancreatectomy and splenectomy) or percutaneous drainage.SettingWalter Reed Army Medical Center.PatientA patient with acute or chronic pancreatitis presented with pleuritic chest pain and fever up to 105°F (40.6°C). A CT of the abdomen and the pelvis demonstrated a splenic abscess.InterventionBecause of the technical inability to perform transpapillary drainage, EUS-guided transgastric drainage resolved the splenic abscess.ConclusionsThis is the first reported case of a splenic abscess treated definitively with endoscopic therapy. In the face of a worsening clinical picture and reported morbidities up to 79% with surgical and percutaneous drainage procedures, endoscopic therapies should be considered in the management of splenic complications of pancreatitis.