Endoscopic Trans-Gastric Drainage of a Peri-Splenic Abscess After Laparoscopic Appendectomy For Perforated Appendicitis: A Case Report

Document Type

Article

Publication Date

7-2025

Publication Title

Journal of Pediatric Surgery Case Reports

Abstract

Introduction: Postoperative abscesses after perforated appendicitis occur in 10–30 % of pediatric patients, but not all are amenable to percutaneous drainage. Case presentation: A 4-year-old female presented with abdominal pain and vomiting and was diagnosed with perforated appendicitis with an associated pelvic abscess. She underwent laparoscopic appendectomy, during which a perforated appendix and diffuse peritoneal contamination were noted. Two 15-French Blake drains were placed intraoperatively. She was admitted to the pediatric intensive care unit (PICU) for close monitoring and received intravenous piperacillin-tazobactam. Drains were removed on postoperative day (POD) 6, and she was discharged on POD 10 with a peripherally inserted central catheter (PICC) for continued outpatient piperacillin-tazobactam infusions. Three days later, she returned with fever, loose stools, recurrent abdominal pain, and a white blood cell count of 45.9 bil/L. Computed tomography (CT) revealed a 4.3-cm peri-splenic abscess. Antibiotics were escalated to meropenem, vancomycin, and metronidazole. As no safe percutaneous access route was available, endoscopic ultrasound (EUS)-guided drainage was performed. Two 7-French, 5-cm double-pigtail plastic stents were placed into the collection. Abscess cultures from the EUS-guided trans-gastric drainage were almost fully suppressed with a few Streptococcus anginosus present. She recovered well, was discharged on post-procedure day 4, and completed 21 days of intravenous meropenem. Follow-up CT on post-procedure day 23 confirmed resolution. Stents were removed as an outpatient procedure 123 days after placement. Conclusion: Trans-gastric endoscopic ultrasound-guided drain placement seems to be an effective approach for upper abdominal abscesses that are not amenable to percutaneous drain placement.

Volume

118

First Page

103029

Last Page

103029

DOI

10.1016/j.epsc.2025.103029

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