Case Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 28, 2014; 20(4): 1119-1122
Published online Jan 28, 2014. doi: 10.3748/wjg.v20.i4.1119
Endoscopic transgastric drainage of a gastric wall abscess after endoscopic submucosal dissection
Osamu Dohi, Moyu Dohi, Ken Inoue, Yasuyuki Gen, Masayasu Jo, Kazuhiko Tokita
Osamu Dohi, Moyu Dohi, Ken Inoue, Yasuyuki Gen, Masayasu Jo, Kazuhiko Tokita, Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto 629-2261, Japan
Author contributions: Dohi O wrote the manuscript; Dohi M, Inoue K, Gen Y, Jo M and Tokita K were also involved in editing the critical revision of the manuscript for important intellectual content.
Correspondence to: Osamu Dohi, MD, PhD, Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama Yosano-Cho, Yosa-gun, Kyoto 629-2261, Japan. osamu-d@koto.kpu-m.ac.jp
Telephone: +81-772-463371 Fax: +81-772-463371
Received: April 23, 2013
Revised: July 31, 2013
Accepted: August 16, 2013
Published online: January 28, 2014
Processing time: 278 Days and 19.6 Hours
Abstract

A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer. Endoscopic submucosal dissection (ESD) was successfully performed for complete resection of the tumor. On the first post-ESD day, the patient suddenly complained of abdominal pain after an episode of vomiting. Abdominal computed tomography (CT) showed delayed perforation after ESD. The patient was conservatively treated with an intravenous proton pump inhibitor and antibiotics. On the fifth post-ESD day, CT revealed a gastric wall abscess in the gastric body. Gastroscopy revealed a gastric fistula at the edge of the post-ESD ulcer, and pus was found flowing into the stomach. An intradrainage stent and an extradrainage nasocystic catheter were successfully inserted into the abscess for endoscopic transgastric drainage. After the procedure, the clinical symptoms and laboratory test results improved quickly. Two months later, a follow-up CT scan showed no collection of pus. Consequently, the intradrainage stent was removed. Although the gastric wall abscess recurred 2 wk after stent removal, it recovered soon after endoscopic transgastric drainage. Finally, after stent removal and oral antibiotic treatment for 1 mo, no recurrence of the gastric wall abscess was found.

Keywords: Gastric wall abscess; Transgastric drainage; Delayed perforation; Endoscopic submucosal dissection; Early gastric cancer

Core tip: In this report, we describe for the first time a case in which a gastric wall abscess caused by delayed perforation after endoscopic submucosal dissection was conservatively treated with endoscopic drainage via the gastric lumen and antibiotics.