A CASE OF LIVER ABSCESS IN WHICH ENDOSCOPIC ULTRASONOGRAPHY-GUIDED DRAINAGE WAS EFFECTIVE

Abstract

We report herein on a 72-year-old man who suffered from liver abscess in the lateral segment due to biliary infection. Endoscopic retrograde cholangiopancreatography (ERCP) was performed on the first day of the illness, and multiple bile duct stones were revealed. A 5Fr nasal bile duct drainage tube was inserted in the bile duct. On the 6^th day, T2-intensified images of MRI demonstrated that the liver abscess in the lateral segment had grown larger, and ascites had collected on the liver surface. The patient had progressive worsening of breathing, and continuous positive pressure ventilation (CPPV) was started on the 7^th day. Although treatment of the liver abscess was needed urgently, it was difficult to puncture the abscess percutaneously because of a large quantity of ascites. Therefore, EUS-guided liver abscess drainage (EUS-LAD) was carried out on the 13^th day, and a 7Fr nasal bile duct drainage tube was inserted in the liver abscess. After drainage, the breathing condition improved, and MRI revealed significant reduction of the abscess on the 40^th day. We consider that EUS-guided drainage is effective and a new therapeutic strategy for liver abscess.