Bacterial liver abscess successfully treated by trans-gastric endoscopic ultrasound aspiration in a critically ill patient

Bacterial hepatic abscesses are the most common kind of intraabdominal abscesses with higher incidence in elderly men.Symptoms are not specific and required close physical examination and imaging study to identify location of fluid collection.Treatment is usually empiric and drainage are commonly required via open or laparoscopic surgeries or percutaneously.Both methods are invasive and carry a risk of complications that increase morbidity and mortality.Endoscopic ultrasound (EUS) has emerged as a less invasive modality with fewer adverse outcomes.Hereby, we present a case of a pyogenic liver abscess in a critically ill elderly man that was successfully aspirated via transgastric approach using EUS technique, and subsequently drained with catheter placement by interventional radiology.EUS aspiration should be considered as an effective initial method of treatment in critically ill patients with pyogenic liver abscesses.