Published online Apr 26, 2023. doi: 10.12998/wjcc.v11.i12.2848
Peer-review started: January 24, 2023
First decision: February 17, 2023
Revised: February 20, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 26, 2023
Acute diverticulitis is one of the most prevalent complications of diverticular disease and may result in abscess formation, perforation, fistula formation, obstruction, or bleeding. Diverticular abscesses may be initially treated with antibiotics and/or percutaneous drainage and/or surgery. Endoscopic ultrasound (EUS)-guided drainage techniques are increasingly used as a minimally invasive alternative to percutaneous or surgical approaches, as they are associated with better treatment outcomes, shorter recovery time and duration of hospitalization.
A 57-year-old female presented to the emergency department on account of abdominal pain and fever. Clinical examination revealed tenderness in the left lower abdominal quadrant, with elevated inflammatory markers in laboratory tests. Abdominal computed tomography (CT) revealed an 8 cm × 8 cm × 5 cm well-encapsulated abscess of the sigmoid colon, surrounded by numerous diverticula. A diagnosis of Hinchey II diverticular abscess was made, and the patient was admitted and commenced on appropriate antibiotic treatment. A transrectal EUS showed a fluid collection in direct contact with the sigmoid colon. Transluminal drainage was performed, and a lumen-apposing metal stent was inserted into the abscess collection. A follow-up CT scan showed a regression of the collection. The patient's general condition improved, and the stent was removed during a follow-up transrectal EUS that revealed no visible collection.
We report the first successful management of a pelvic abscess in patient with Hinchey II acute diverticulitis using EUS-guided transluminal drainage in Slovenia. The technique appears effective for well-encapsulated intra-abdominal abscesses larger than 4 cm in direct contact with the intestinal wall of left colon.
Core Tip: The incidence of colonic diverticulosis and its complications is rising in developed countries. An abscess due to acute diverticulitis may be initially treated with antibiotics and/or percutaneous drainage and/or surgery. Since percutaneous drainage of an abscess is not always feasible, endoscopic ultrasound-guided transluminal drainage seems to be an effective minimally invasive alternative for well-encapsulated intra-abdominal abscesses lying in direct contact with the intestinal wall, which reduces the need for surgery and stoma formation in selected patients. However, given the limitations of the supporting evidence, the optimal treatment strategy should be determined on a case-by-case basis by a multidisciplinary team.