EUS-guided pelvic abscess drainage with use of a biflanged metal stent through the perianal transgluteal route

Recently, the efficacy of EUS-guided transrectal stent placement for pelvic abscess drainage has been reported, with good outcomes. However, there are several limitations of the transrectal drainage, such as insufficient drainage in case of a large abscess owing to a small-caliber stent or the possibility of stent migration. Herein, we describe EUS-guided pelvic abscess drainage with use of a biflanged metal stent through the perianal transgluteal route. A 69-year-old man with a 35-mm pelvic mass underwent EUS-guided FNA. The pathologic finding indicated no malignant cells. One month after EUS-FNA, the patient was admitted to the hospital with a high fever and gluteal pain. CT showed a 100-mm pelvic abscess at the same site of the pelvic mass. In this case, EUS could very well depict the longitudinal image of the abscess through the perianal transgluteal route compared with the transrectal route. Thus, we performed EUS-guided drainage using a dedicated fully covered biflanged metal stent for EUS (14 mm in diameter and 30 mm long) through the perianal transgluteal route with the patient under conscious sedation and analgesia (Fig. 1; Video 1, available online at www.giejournal.org). The tip of the echoendoscope was fixed by an assistant during the procedure. Rapid complete resolution of the pelvic abscess was achieved in 2 days, and eventually the metal stent was removed.