Management of pelvic abscess complicating a rectoanal fistula using endoscopic ultrasound-guided drainage with an electrocautery-enhanced lumen-apposing metal stent.

Monino, Laurent [UCL] Piessevaux, Hubert [UCL] Denis, Marie Armelle [UCL] Moreels, Tom [UCL]

(eng) The management of pelvic abscess is mainly radiological or surgical. The use of electrocautery-enhanced lumen-apposing metal stents (LAMS) allows efficient drainage of intra-abdominal collections. A few retrospective studies and case series have demonstrated the feasibility and safety of EUS-guided drainage of pelvic abscesses. We present a case of a large pelvic abscess complicating a rectoanal fistula that was successfully drained without recurrence using an electrocautery-enhanced LAMS. During the lockdown due to COVID-19, an 81-year-old woman waited 1 month before attending the emergency room for rectoanal pain with fever. On her admission, computed tomography and magnetic resonance imaging showed a large pelvic abscess measuring 11 cm ([Fig. 1]). The location of the pelvic abscess did not allow for radiological drainage, and the patient’s medical history precluded surgical management. EUS-guided drainage of the pelvic abscess was performed a week after the patient’s admission ([Video 1]). [...]