Peritonitis due to Ruptured Splenic Abscess Managed by Trans-gastric Endoscopic Ultrasonography-guided Dual Drainage Combined with Lavage and Intermittent Negative Pressure: A Case Report and Literature Review

Intern Med. 2026 Feb 1;65(3):438-446. doi: 10.2169/internalmedicine.5773-25. Epub 2025 Jul 10.

Abstract

There are no established guidelines for managing patients with rare but fatal ruptured splenic abscesses. In this clinical scenario, open splenectomy seems to be a standard literature-based intervention. However, open splenectomy under general anesthesia is not a priority in high-risk surgical patients. We herein report an endoscopic ultrasound-guided transmural dual drainage combined with lavage and intermittent negative pressure drainage as an alternative to surgery for a critical patient with a ruptured splenic abscess and discuss the benefits and drawbacks of open splenectomy as a case report and literature review.

Keywords: abscess; drainage; endosonography; peritonitis; rupture; spleen.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Abscess* / complications
  • Abdominal Abscess* / diagnostic imaging
  • Abscess* / complications
  • Abscess* / diagnostic imaging
  • Abscess* / therapy
  • Drainage* / methods
  • Endosonography* / methods
  • Humans
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy* / methods
  • Peritonitis* / diagnosis
  • Peritonitis* / diagnostic imaging
  • Peritonitis* / etiology
  • Peritonitis* / therapy
  • Splenectomy
  • Splenic Diseases* / complications
  • Splenic Diseases* / diagnostic imaging
  • Splenic Diseases* / therapy
  • Splenic Rupture* / complications
  • Splenic Rupture* / diagnostic imaging
  • Therapeutic Irrigation / methods