Splenic abscesses are rare and often refractory to antibiotic therapy. Percutaneous drainage may not be feasible due to limited anatomical access, and surgical treatment is invasive. We report the case of a 62-year-old man with multiple comorbidities including morbid obesity and type II diabetes who was admitted due to sepsis secondary to vertebral osteomyelitis. Contrast-enhanced abdominal CT scan revealed a 44mm well-demarcated fluid collection with a thickened capsule consistent with a splenic abscess. Endoscopic ultrasound (EUS) confirmed a 40mm hypo-/anechoic collection accessible from the gastric body. EUS-guided transgastric drainage was performed using a 10×10mm lumen-apposing metal stent (LAMS), resulting in immediate purulent drainage into the gastric cavity. The patient improved rapidly and CT scan confirmed complete resolution of the abscess. LAMS was removed after one week.

We investigated how many cases of EUS-guided splenic abscess drainage have been performed so far. We conducted a systematic literature review on PubMed using the searching terms “splenic abscess” AND “endoscopic drainage” or “lumen-apposing metal stent”. We included all studies and case reports describing a comparable scenario to the presented case.

Our search retrieved eight publications describing a total of ten cases of EUS-guided splenic abscess drainage. Three abscesses were drained with a plastic stent and four using a pigtail stent. Only three of the previously described cases involved LAMS placement.

Regardless of the etiology and predisposing factors, EUS-guided drainage using LAMS is a safe, effective, and less invasive treatment option compared to surgical or percutaneous drainage.