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Endoscopic Drainage of an Intrahepatic Abscess Secondary to a Perforated Gallbladder

Parekh, Parth J. MD, FACP1; Shakhatreh, Mohammad H. MD, MPH2; Desai, Meeta R. MD2; Yeaton, Paul MD2

ACG Case Reports Journal: July 2019 - Volume 6 - Issue 7 - p 1
doi: 10.14309/crj.0000000000000108
VIDEO
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SDC

1Department of Internal Medicine, Division of Gastroenterology and Hepatology, Eastern Virginia Medical School, Norfolk, VA

2Department of Internal Medicine, Division of Gastroenterology and Hepatology, Carilion Clinic, Roanoke, VA

Correspondence: Parth J. Parekh, MD, FACP, Eastern Virginia Medical School, Norfolk VA 23510 (parthjparekh@gmail.com).

Received December 18, 2018

Accepted March 26, 2019

Online date: July 15, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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CASE REPORT

A 68-year-old woman presented with abdominal pain, nausea, vomiting, and altered mental status. Subsequent imaging demonstrated a well-circumscribed nonenhancing fluid collection within the hepatic parenchyma adjacent to the gallbladder. Management was discussed in a multidisciplinary manner, and a decision was made to pursue endoscopic management with a single anesthetic. Endoscopic retrograde cholangiopancreatography with biliary sphincterotomy and clearance of the bile duct, endoscopic ultrasound puncture of the gallbladder from the duodenum and placement of a lumen-apposing stent (ie, creation of a cholecystoduodenostomy), and placement of a double pigtail into the hepatic abscess were performed. The procedure was successful without any intraoperative or postoperative complications. Follow-up imaging demonstrated near-resolution of the abscess. Repeat endoscopy was performed to remove the remaining stones from the gallbladder. At follow-up, the patient remained well and was symptom-free (Video 1, watch the video at http://links.lww.com/ACGCR/A11).

Endoscopic management of gallbladder disease has recently come into favor, with the current literature supporting its efficacy and safety profile.1 Endoscopic management of complications from gallbladder disease, however, has yet to be described. We present a novel approach to endoscopic management of an intrahepatic abscess in the setting of a perforated gallbladder. The advent of endoscopic ultrasound has broadened the horizon of interventional endoscopy by allowing endoscopists to visualize and access organs and adjacent intra-abdominal pathology near the gastrointestinal tract. Recently, the utility of endoscopic ultrasound has expanded from a mainly diagnostic role (ie, staging gastrointestinal malignancy and tissue acquisition for the diagnosis of gastrointestinal malignancy) to include a more therapeutic role (ie, drainage of intra-abdominal fluid collections, alternative approach to biliary and pancreatic duct drainage).

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DISCLOSURES

Author contributions: PJ Parekh drafted the manuscript and is the article guarantor. PJ Parekh, MH Shakhatreh, MR Desai, and P. Yeaton critically revised the manuscript.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

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REFERENCE

1. Adler DG. EUS-guided gallbladder drainage: Current status and future prospects. Endosc Ultrasound. 2018;7(1):1–3.

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