Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report
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 asso...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576625000740 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849717457333256192 |
|---|---|
| author | Ryan T. Davis Ibrahim B. Baida Katelyn R. Ward Laith H. Jamil Begum Akay Nathan M. Novotny |
| author_facet | Ryan T. Davis Ibrahim B. Baida Katelyn R. Ward Laith H. Jamil Begum Akay Nathan M. Novotny |
| author_sort | Ryan T. Davis |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e59d6bc815734c4988b8ca92b57580dd |
| institution | DOAJ |
| issn | 2213-5766 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj-art-e59d6bc815734c4988b8ca92b57580dd2025-08-20T03:12:39ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662025-07-0111810302910.1016/j.epsc.2025.103029Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case reportRyan T. Davis0Ibrahim B. Baida1Katelyn R. Ward2Laith H. Jamil3Begum Akay4Nathan M. Novotny5Corewell Health William Beaumont University Hospital, USA; Corresponding author. 3601 West 13 Mile Road, Royal Oak, MI, 48073, USA.Corewell Health William Beaumont University Hospital, USACorewell Health William Beaumont University Hospital, USASection of Gastroenterology and Hepatology, Corewell Health William Beaumont University Hospital, USA; Oakland University William Beaumont School of Medicine, USACorewell Health Children's at William Beaumont University Hospital, USACorewell Health Children's at William Beaumont University Hospital, USAIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2213576625000740Trans-gastric drainageEndoscopic-guided drainagePerforated appendicitisPostoperative abscessCase report |
| spellingShingle | Ryan T. Davis Ibrahim B. Baida Katelyn R. Ward Laith H. Jamil Begum Akay Nathan M. Novotny Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report Journal of Pediatric Surgery Case Reports Trans-gastric drainage Endoscopic-guided drainage Perforated appendicitis Postoperative abscess Case report |
| title | Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report |
| title_full | Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report |
| title_fullStr | Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report |
| title_full_unstemmed | Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report |
| title_short | Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report |
| title_sort | endoscopic trans gastric drainage of a peri splenic abscess after laparoscopic appendectomy for perforated appendicitis a case report |
| topic | Trans-gastric drainage Endoscopic-guided drainage Perforated appendicitis Postoperative abscess Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2213576625000740 |
| work_keys_str_mv | AT ryantdavis endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport AT ibrahimbbaida endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport AT katelynrward endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport AT laithhjamil endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport AT begumakay endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport AT nathanmnovotny endoscopictransgastricdrainageofaperisplenicabscessafterlaparoscopicappendectomyforperforatedappendicitisacasereport |