Endoscopic ultrasound-guided pelvic abscess drainage: a report of 2 cases and literature review

Background Drainage is essential for source control of the infection in a pelvic abscess. The purpose of this study was to report 2 cases of endoscopic ultrasound (EUS)-guided drainage of the pelvic abscess and review the literature of different modalities of EUS-guided drainage of pelvic abscess. Case presentation A 60-year-old male developed a pelvic abscess 1 month after laparoscopic complete tumor resection. An abdominal CT showed a mass shadow (about 7.1 cm × 5.1 cm) in the right pelvic region. Another case was an 85-year-old male who developed a pelvic abscess 3 days after recurrent tumor resection of multiple organs. The CT showed pelvic effusion and gas accumulation (approximately 6.5 cm × 4.2 cm), and the intestinal tube above the small intestinal anastomosis was dilated with effusion. A 19G-A puncture needle was used to puncture the abscess. An 8-mm cylindrical balloon was inserted, followed by a 10 Fr-3 cm double pigtail stent and an 8.5 Fr drainage tube. After EUS-guided drainage of pelvic abscess, the symptoms disappeared without recurrence. Conclusions EUS-guided drainage is an effective and safe method for treating pelvic abscesses as long as the drainage modality is appropriately selected based on the etiology, size, and mucus viscosity of the abscess.

258 MANAGEMENT OF OESOPHAGO-GASTRIC LEAKS FOLLOWING MINIMALLY INVASIVE IVOR LEWIS OESOPHAGO-GASTRECTOMY USING DOUBLE PIGTAIL STENTS

Anastomotic leak following Ivor Lewis oesophago-gastrectomy is a major complication with high morbidity and mortality. We report our experience with three such cases where endoscopically deployed double pigtail stents (DPT) were used to help manage the leaks. Methods Three patients from October 1, 2019 to February 29, 2020 experienced leakage from the oesophago-gastric anastomosis following minimally invasive Ivor Lewis oesophago-gastrectomy. These occurred on post-operative day 9, day 29 and day 7 respectively. All cases were managed with endoscopic deployment of double pigtail stents along with other adjunctive measures. Results To date all patients remain alive, with sepsis under control. One of the patients had been able to have his double pigtail stent removed at six weeks and he has been able to commence adjuvant chemotherapy. Another patient had a follow-up contrast study one week after DPT insertion which showed no further contrast extravasation and was able to recommence oral intake. The third patient has a left empyema (managed conservatively with a combination of internal DPT and external pigtail drainage) which is gradually resolving. Conclusion Endoscopically deployed DPTs are a useful tool in the armamentarium for managing oesophago-gastric anastomotic leaks in selected patients following Ivor Lewis oesophago-gastrectomy. They are advantageous in that stent migration does not appear to be an issue, nor is there any problem with leakage around the stent. Patients are mostly able to restart oral intake soon after insertion of DPTs. This reduces the morbidity associated with these anastomotic leaks, and reduces the number of interventions needed.

Outcome of percutaneous transhepatic biliary drainage (ptbd) in patients with ascites

Introduction: Malignant obstructive jaundice with ascites ussually occurs in patients with advanced cancer stage. In these patients sometime the best treatment option is percutaneous transhepatic biliary drainage (PTBD). PTBD is a safety and effective procedure. Materials and Methods: To evaluate outcome of PTBD in patients with ascites. Case series report Results: From 2013 to 2019, there were 21 malignant obstructive jaundice with ascites perfomed PTBD. All of 21 patients were performed paracentesis prior to PTBD. The successful rate was 95.2% (20 cases). One case failed because of thick biliary wall ,we could not insert pigtail stent. Complications rate was 23.8%. Complications were cholangitis (4 cases), biliopleural fistula (1 case). Biliopleural fistula resolved by pleural cavity drainage. Other complication cases were successfully treated conservatively. There was no mortality case. Conclusions: PTBD in patiens with ascites can be performed safety and effectively if paracentesis was done prior to PTBD. Keywords: Percutaneous transhepatic biliary drainage, PTBD, ascites. Tóm tắt Đặt vấn đề: Tắc mật do nguyên nhân ác tính kèm theo báng bụng thường xảy ra ở những người bệnh ung thư giai đoạn tiến xa. Ở những người bệnh này, đôi khi dẫn lưu đường mật xuyên gan qua da là lựa chọn điều trị duy nhất. Dẫn lưu đường mật xuyên gan qua da là thủ thuật an toàn và hiệu quả. Tuy nhiên, khi có báng bụng thì nguy cơ biến chứng tăng lên. Phương pháp nghiên cứu: Đánh giá kết quả dẫn lưu đường mật xuyên gan qua da ở người bệnh có báng bụng, nghiên cứu loạt ca. Kết quả: Trong thời gian từ 2013 - 2019, có 21 người bệnh tắc mật do nguyên nhân ác tính và có báng bụng được thực hiện dẫn lưu đường mật xuyên gan qua da (PTBD). Cả 21 trường hợp đều được dẫn lưu dịch ổ bụng trước khi thực hiện PTBD. Tỷ lệ thành công là 95,2% (20 trường hợp). Trường hợp thất bại là do đường mật viêm dày nên thành đường mật cứng chắc, không luồng ống vào lòng đường mật được. Biến chứng xảy ra ở 23,8% các trường hợp. Các biến chứng bao gồm viêm đường mật (04 trường hợp), rò mật vào khoang màng phổi (01 trường hợp), trường hợp rò mật vào khoang màng phổi được dẫn lưu màng phổi. Các trường hợp biến chứng khác được điều trị bảo tồn. Không có trường hợp nào tử vong. Kết luận: Dẫn lưu đường mật xuyên gan qua da trên người bệnh có báng bụng có thể thực hiện một cách khả thi và an toàn nếu dẫn lưu dịch ổ bụng trước thủ thuật.

Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study

Background. Ureteral stent intolerance reduces patients’ quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread. Materials and Methods. After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer. Results. A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 p=0.001. Conclusion. Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.