Successful Ultrasound-Guided Percutaneous Drainage of Multiple Splenic Abscesses in a Kidney Transplant Patient With Encapsulated Sclerosing Peritonitis: A Case Report

Percutaneous Drainage of a Splenic Abscess via Laparoscopic Trocar in a Kidney Transplant Patient

Spleen abscess is a life-threatening disease. Treatment can be done by medical, radiological, or surgical methods. Here, we offer an innovative method of laparoscopic trocar-assisted percutaneous abscess drainage in the treatment of splenic abscess. Our patient, a 48-year-old male who had a kidney transplant 3 years previously, was admitted due to abdominal pain and fever. A-25-cm splenic abscess was detected, and ultrasonography-guided percu-taneous catheter 10F drainage was attempted. However, this attempt was not successful due to the high viscosity of the abscess content. Under general anesthesia, we then attempted abscess drainage percutaneously via a 12-mm laparoscopic trocar, and a large-bore drain of 28F was inserted into the abscess cavity. The drainage was successful (5300 mL high viscosity content) without any complications. The patient was discharged on day 8 and remained well at 9-month follow-up. Percutaneous drainage instead of splenectomy is preferred in the treatment of spleen abscess by preserving the immunologic functions of the spleen, particularly in immunocompromised patients. When percutaneous catheter drainage therapy fails, percutaneous treatment with a laparoscopic trocar is an innovative and reliable alternative.

Surgical Management of Encapsulating Peritoneal Sclerosis: A Case Report in Kidney Transplant Patient

Introduction

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of progressive fibrotic change in response to prolonged, repetitive, and typically severe insult to the peritoneal mesothelium, often occurring in the setting of peritoneal dialysis (PD). Clear guidelines for successful management remain elusive. We describe the successful surgical management of EPS in a 28-year-old male s/p deceased donor kidney transplant for end-stage renal disease (ESRD) secondary to focal segmental glomerulosclerosis (FSGS). This patient received PD for 7 years but changed to hemodialysis (HD) in the year of transplant due to consistent signs and symptoms of underdialysis. EPS was visualized at the time of transplant. Despite successful renal transplantation, EPS progressed to cause small bowel obstruction (SBO) requiring PEG-J placement for enteral nutrition and gastric decompression. The patient subsequently developed a chronic gastrocutaneous fistula necessitating chronic TPN and multiple admissions for pain crises and bowel obstruction. He was elected to undergo surgical intervention due to deteriorating quality of life and failure to thrive. Surgical management included an exploratory laparotomy with extensive lysis of adhesions (LOA), repair of gastrocutaneous fistula, and end ileostomy with Hartmann's pouch. Postoperative imaging confirmed resolution of the SBO, and the patient was transitioned to NGT feeds and eventually only PO intake. He is continuing with PO nutrition, gaining weight, and free from dialysis.

Conclusion

Surgical intervention with LOA and release of small intestine can be successful for definitive management of EPS in the proper setting. In cases such as this, where management with enteral nutrition fails secondary to ongoing obstructive episodes, surgical intervention can be pursued in the interest of preserving quality of life.