Endoscopic transgastric drainage of postoperative abdominal abscess after laparoscopic-assisted distal gastrectomy

Although rare, intra-abdominal abscess is one possible postoperative complication of gastrectomy for gastric cancer that requires proper management. Generally, CT-guided or echo-guided percutaneous drainage is the first choice as a less-invasive approach, but percutaneous puncture is sometimes difficult because of surrounding viscera. In our case, an obese woman developed intra-abdominal abscess after laparoscopic distal gastrectomy for gastric cancer. The abscess was surrounded by abdominal organs and was difficult to puncture percutaneously. The patient was therefore treated by endoscopic ultrasonography (EUS)-guided drainage through the wall of the remnant stomach. We successfully achieved safe EUS-guided drainage, because EUS clearly showed perigastric abscess and the common hepatic artery. This case demonstrates trans-gastric drainage of perigastric abscess as a safe, less-invasive procedure, even for the remnant stomach after laparoscopic distal gastrectomy.