講演情報
[JKS2-1]Indications and Outcomes of Treatment for Abdominal Abscesses
Hidenori Tanaka, Shiro Oka (Hiroshima University Hospital)

Background: Abdominal abscesses are commonly managed by antibiotics, percutaneous drainage, or surgery. However, recent advances in therapeutic endoscopy have enabled internal drainage approaches. We present two cases in which endoscopic interventions were applied, highlighting the key indications and technical considerations.
Case 1: A 74-year-old man developed a localized abscess in the descending colon wall. Endoscopic ultrasonography (EUS) confirmed an intramural abscess. A direct mucosal incision was made using a needle-type knife, allowing spontaneous drainage of the purulent contents. The procedure was completed without complications, and the abscess resolved completely. This case demonstrates that direct endoscopic incision is a feasible option for intramural abscesses when the cavity is well-demarcated, protrudes into the lumen, and EUS confirms intramural location and vascular safety.
Case 2: A 23-year-old man with ulcerative colitis underwent ileal pouch-anal anastomosis, after which he developed a presacral sinus. Despite multiple interventions including CT-guided drainage, endoscopic clip closure and transanal surgery, the sinus persisted. Endoscopic sinusotomy was performed using an insulated-tip knife to open the sinus into the ileal pouch, allowing unification of them. This case demonstrates that endoscopic sinusotomy can be a first-line option in suitable cases, especially when a visible fistula is present and the sinus tract is short and accessible.
Conclusion: Endoscopic treatment offers a minimally invasive option for abdominal abscesses. When lesion location and characteristics are properly assessed, especially using EUS, these procedures can be performed safely and effectively in selected benign cases.
Case 1: A 74-year-old man developed a localized abscess in the descending colon wall. Endoscopic ultrasonography (EUS) confirmed an intramural abscess. A direct mucosal incision was made using a needle-type knife, allowing spontaneous drainage of the purulent contents. The procedure was completed without complications, and the abscess resolved completely. This case demonstrates that direct endoscopic incision is a feasible option for intramural abscesses when the cavity is well-demarcated, protrudes into the lumen, and EUS confirms intramural location and vascular safety.
Case 2: A 23-year-old man with ulcerative colitis underwent ileal pouch-anal anastomosis, after which he developed a presacral sinus. Despite multiple interventions including CT-guided drainage, endoscopic clip closure and transanal surgery, the sinus persisted. Endoscopic sinusotomy was performed using an insulated-tip knife to open the sinus into the ileal pouch, allowing unification of them. This case demonstrates that endoscopic sinusotomy can be a first-line option in suitable cases, especially when a visible fistula is present and the sinus tract is short and accessible.
Conclusion: Endoscopic treatment offers a minimally invasive option for abdominal abscesses. When lesion location and characteristics are properly assessed, especially using EUS, these procedures can be performed safely and effectively in selected benign cases.