Korean J Gastroenterol.  2017 May;69(5):321-324. 10.4166/kjg.2017.69.5.321.

Isolated Pyogenic Pancreatic Abscess Successfully Treated via Endoscopic Ultrasound-guided Drainage

Affiliations
  • 1Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea. gipb2592@wku.ac.kr

Abstract

An isolated pyogenic pancreatic abscess (IPPA) without pancreatitis is extremely rare but can occur in patients with uncontrolled diabetes. This pathologic condition poses a clinical challenge in diagnosis and management because it can be confused easily with a malignancy. Endoscopic ultrasound (EUS) may be a useful diagnostic modality for indeterminate pancreatic lesions and IPPA. Here, we report two cases with elevated carbohydrate antigen 19-9 levels and pancreatic masses on cross sectional imaging. The patients were subsequently diagnosed with IPPA by EUS. EUS-guided drainage was performed successfully and the patients' clinical symptoms and radiologic findings improved. In our experience, EUS and EUS-guided drainage are crucial steps for the diagnosis and management of patients with an indeterminate pancreatic lesion. In addition, EUS-guided drainage has excellent technical and clinical outcomes for the treatment of IPPA.

Keyword

Pancreas; Abscess; Drainage

MeSH Terms

Abscess*
Diagnosis
Drainage*
Humans
Pancreas
Pancreatitis
Ultrasonography

Figure

  • Fig. 1 (A) Transverse abdominal CT scans shows an ill-defined low attenuating mass (white arrow) along the pancreatic head. (B) T-2 weighted images demonstrate high signal intensity (black arrow) in the central portion of the mass. (C) A 20-G FNA needle (white arrow) entering the ill-defined low echoic lesion for aspiration is visible. (D) Yellowish pus discharge from the aspiration fluid collected by EUS-FNA. (E) Fluoroscopic view, demonstrating a naso-abscess catheter (5 Fr) placed into the abscess cavity through the duodenal wall. (F) Follow-up CT shows the resolution of an isolated pyogenic pancreatic abscess. CT, computed tomography; FNA, fine needle aspiration; EUS, endoscopic ultrasound.

  • Fig. 2 (A) Non-contrast enhanced abdominal CT showing an exophytic mass in the uncinate process of the pancreas. (B) On EUS, a heterogeneous low echoic lesion with floating echogenic materials (white arrow) is visible. (C) EUS image of the 2nd abscess drainage using a 22 gauge needle in the remaining abscess cavity. (D) After 3 months, abdominal CT shows the resolved state of the exophytic pancreatic mass. CT, computed tomography; EUS, endoscopic ultrasound.


Reference

1. Liu Q, He Z, Bie P. Solitary pancreatic tuberculous abscess mimicking pancreatic cystadenocarcinoma: a case report. BMC Gastroenterol. 2003; 3:1.
2. Arya M, Arya PK. Pancreatic abscess caused by s. typhi. Indian J Med Microbiol. 2001; 19:18–19.
3. Yi SY, Tae JH. Pancreatic abscess following scrub typhus associated with multiorgan failure. World J Gastroenterol. 2007; 13:3523–3525.
4. Eliashiv A, Olumide F, Norton L, Eiseman B. Depression of cell-mediated immunity in diabetes. Arch Surg. 1978; 113:1180–1183.
5. Peleg AY, Weerarathna T, McCarthy JS, Davis TM. Common infections in diabetes: pathogenesis, management and relationship to glycaemic control. Diabetes Metab Res Rev. 2007; 23:3–13.
6. Chong VH. Isolated pyogenic pancreatic abscess mimicking a neoplasm. JOP. 2008; 9:309–312.
7. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol. 2002; 97:1386–1391.
8. Seewald S, Groth S, Omar S, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. 2005; 62:92–100.
9. Fernández-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Débridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg. 1998; 228:676–684.
10. Kida M, Itoi T. Current status and future perspective of interventional endoscopic ultrasound in Japan. Dig Endosc. 2009; 21:Suppl 1. S50–S52.
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr