Endoscopic ultrasound-guided drainage for a pyogenic liver abscess unsuitable for percutaneous drainage

A 40-year-old man presented with fever and was referred to our hospital. Blood tests revealed elevated hepatobiliary enzymes and inflammatory markers, and contrast-enhanced computed tomography showed a 50-mm liver abscess in segment 8. Abdominal ultrasonography failed to secure a safe puncture route, and a percutaneous approach was considered infeasible. Despite treatment with piperacillin/tazobactam, fever and inflammation persisted. Endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) was performed, and a 10-mm fully covered self-expandable metal stent and coaxial 7-Fr double pigtail plastic stent are placed via the duodenum. Klebsiella pneumoniae was isolated from blood and abscess cultures. Follow-up imaging showed marked reduction of the abscess, then the patient was discharged. The stents were subsequently removed, with no recurrence observed. In this case, EUS-LAD is an effective option for the liver abscess unsuitable for percutaneous drainage.