Kumari Piryanka, MD1, Michael G Harris, DO1, Jimmy Giang, DO1, John S Goff, MD2 1Parkview Medical Center, Pueblo, CO; 2Rocky Mountain Gastroenterology, Lakewood, CO
Introduction: Pancreatic pseudocysts are well-defined encapsulated fluid collections without solid components. They usually resolve spontaneously in a period of 4-6 weeks and require no intervention. Persistent and symptomatic pseudocysts should be drained surgically, percutaneously, or endoscopically. The endoscopic AXIOS stent and electrocautery delivery system is a lumen-apposing metallic stent (LAMS) approved for drainage of pancreatic fluid collections including pseudocysts. Here we present a case of a pancreatic pseudocyst treated with cystogastrostomy and AXIOS stent placement later complicated by abscess formation.
Case Description/Methods: A 52-year-old male with a history of decompensated alcoholic cirrhosis was seen in clinic for epigastric pain of 2 months duration. His pain was characterized as epigastric pressure radiating to the back. The symptoms were aggravated by alcohol and large meals. It was relieved by opiate medications. Laboratory studies included lipase 2121, total bilirubin 3.7, AST/ALT 44/53, alkaline phosphatase 308. Computed tomography (CT) of the abdomen showed a large cystic mass within the pancreatic body. EUS was performed with findings of a single compartment cyst within the pancreatic body with no septae and internal debris. Cystogastrostomy was performed with an AXIOS stent resulted in the removal of 1600cc of dark red fluid. CT abdomen was repeated in one month for follow-up and showed resolution of the cyst. The initial plan was to remove the stent in the next week, but the patient did not follow up for financial reasons. He was admitted to the hospital six months later with abdominal pain and sepsis. CT abdomen showed a new pancreatic fluid collection with septations concerning for a pancreatic abscess. A percutaneous drain was placed with 440 cc of fluid drained. Fluid analysis showed 74mcL WBC with 72% neutrophils with cultures positive for Strep anginosus. There was concern that the AXIOS stent acted as a nidus for infection and was subsequently removed. The patient was successfully sent home with antibiotics.
Discussion: The success rate for endoscopic treatment of pseudocysts is more than 70%. Complications of endoscopic AXIOS stent placement include infection, bleeding, perforation, and stent migration. Our case highlights abscess formation as a potential late complication following AXIOS stent placement. In this case, abscess formation was associated with prolonged stent placement (6 months) with the stent likely being a foreign body nidus of infection.
Figure: AXIOS stent in stomach
Disclosures: Kumari Piryanka indicated no relevant financial relationships. Michael G Harris indicated no relevant financial relationships. Jimmy Giang indicated no relevant financial relationships. John S Goff indicated no relevant financial relationships.
Kumari Piryanka, MD1, Michael G Harris, DO1, Jimmy Giang, DO1, John S Goff, MD2. P2784 - Cysto-Gastrostomy and Endoscopic Ultrasound-Guided Placement of AXIOS System With Pancreatic Abscess as a Late Complication, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
