Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
Kyung Rok Kim , Ki Nam Shim
, A Reum Choe
, Min Jong Lee
, Ye Hyun Park
, Eun Mi Song
, Chung Hyun Tae
, Sung Ae Jung
Correspondence to: Kyung Rok Kim
ORCID https://orcid.org/0000-0003-3778-0058
E-mail dkflak80@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver.
Published online January 26, 2023
Copyright © Gut and Liver.
Gastric wall abscess is a rare condition characterized by a purulent inflammatory process resulting in the formation of a pocket of pus in the stomach. As the mucosa is usually intact, it requires various tools such as endoscopic ultrasonography or computed tomography for the differential diagnosis to rule out more common subepithelial tumors. Even after the diagnosis, the treatment for gastric wall abscess was previously restricted to surgical resection in combination with antibiotics. Currently, in order to avoid unnecessary surgery, the alternative method of initial treatment with an endoscopic approach is recommended. It also helps to choose appropriate antibiotics with confirmation of the pathogen by drainage. There are few reports that describe the detailed processing of the endoscopic drainage, and there is no consensus on the treatment. The pathogens that cause gastric wall abscess are usually Streptococci, Staphylococci, and Escherichia coli. There is only one case reported to be caused by Candida albicans. This is the first report of Elizabethkingia anopheles as the pathogen of the gastric wall abscess. Here, we report a case of gastric wall abscess in a 75-year-old man, safely treated by endoscopic drainage and antibiotics, confirmed by isolating the contents of the abscess.
Keywords: Abdominal abscess, Phlegmon, Suction drainage, Case reports
Gastric wall abscess is a rare disease and difficult to diagnose. Due to the characteristics of the abscess, it is difficult to culture and the therapeutic effect of empirical antibiotics can be restricted. Until now, most gastric abscess required surgical intervention if there was no response to empirical antibiotics. However, endoscopic approach is emerging as an alternative method. Here we report a unique case of gastric wall abscess treated by endoscopic drainage and specified antibiotics by culture results. The patient provided written informed consent for the publication.
A 75-year-old man visited a primary medical clinic, presenting with epigastric pain, anorexia, and vomiting. He had a history of hepaticojejunostomy due to calculous cholecystitis. He was referred to our hospital and admitted for further evaluation of the mass found on the abdominal ultrasound. In the initial laboratory results, the white blood cell count was 10,550/mL and C-reactive protein level was elevated to 4.25 mg/dL (normal range, <0.05 mg/dL). Computed tomography (CT) of the abdomen identified about 4 cm sized low-density mass-like lesion with peripheral enhancement which invaded the gastric antral submucosa, which was compatible with abscess (Fig. 1A). A 6.4-cm-sized large mass with multiple small nodular lesions in peripheral portion compatible with abscess was detected in the left lateral segment of the liver. Later, the mass in the liver was diagnosed as intrahepatic cholangiocarcinoma by ultrasound-guided liver biopsy and positron emission tomography/CT. Treatment for gastric abscess with empirical broad-spectrum antibiotics (intravenous [IV] ceftriaxone 2 g every 24 hours) was initiated. Despite treatment, during the first 4 hospital days, his pain did not improve and fever up to 38.8°C developed. White blood cell increased to 16,480/mL and the C-reactive protein level increased to 6.66 mg/mL, but there was no growth in the blood culture. We changed antibiotics (meropenem 1 g IV every 12 hours) and performed an esophagogastroduodenoscopy with endoscopic ultrasonography (EUS). Esophagogastroduodenoscopy showed a huge subepithelial tumor (Fig. 1B) and EUS showed about 4.3×2.5 cm sized homogenous mass with mixed echo from the third layer at the anterior wall of the antrum, which filled with liquified material, and air fluid level was noted (Fig. 1C). We performed endoscopic incision and drainage immediately. After the injection of saline (Fig. 2A), about 1.5-cm-sized incision up to the submucosal layer was done by H-knife (Clear-Cut Knife H type, Finemedix Co., Ltd., Daegu, Korea) (Fig. 2B). Clear fluids gushed out from the opening (Fig. 2C). An endoscopic retrograde cholangiopancreatography catheter was introduced to the opening to the abscess pocket, and aspiration was done for the culture studies (Fig. 2D). About 20 mL of saline irrigation into the lesion was done. After the procedure, the lesion was markedly collapsed (Fig. 2E). Over the following 3 days, dramatic improvement of epigastric pain was achieved. The culture from the drained fluid detected
An intramural gastric abscess is a localized form of phlegmonous gastritis.1 The most common manifestation of phlegmonous gastritis is the diffuse involvement of the gastric submucosa extending into all layers of the gastric wall. A localized form is relatively rare, accounting for 5% to 15% of all phlegmonous gastritis.2 A purulent inflammatory process results in the forming of a pocket of pus, usually in the antrum and pylorus, but it can develop in any location of the stomach.3 The submucosa of the involved lesion may be thickened, and the flattened mucosa almost looks intact, so we need to rule out subepithelial tumors such as gastrointestinal stromal tumors.4
As the pathogenesis of phlegmonous gastritis is unknown, the cause of the intramural gastric abscess is not certain. The possible causes are the direct bacterial invasion through the damaged gastric mucosa. Another source can be an infection by lymphatic or hematogenous dissemination.2 To the best of our knowledge, the most common pathogens are
First described in 2005,
The intramucosal gastric abscess or phlegmonous gastritis is known to be related with heavy alcoholics, immunocompromised state such as human immunodeficiency virus infection, nutrition deficiency, diabetes mellitus, chronic kidney disease, leukemia, multiple myeloma, rheumatoid arthritis, and chronic steroid use. Also, the secondary type of phlegmonous gastritis is associated with the infection of other organs, such as biliary infection or hepatic abscess.9-11 In our case, he had anorexia because of persistent vomiting and epigastric pain. Nutrition deficiency was another risk factor for poor general condition.
The protruding mass with normal-looking mucosal appearance of gastric abscess is similar to that of subepithelial tumors. CT and EUS are helpful in the diagnosis of gastric abscess. Enhanced abdominal CT shows a low-density mass with peripheral ring enhancement. A typical EUS finding is the thickening of the gastric wall with a localized hypoechoic mass, which has heterogeneously mixed echogenicity.12 EUS is superior to CT scan in measuring the contents of mass, the depth, and extent of invasion. We could notice liquified materials and air-fluid level. Even after CT and EUS, it can be confused with cancerous lesions. To avoid misdiagnosis, fine-needle aspirationis are useful and if there is any purulent fluid leakage from the lesion site, an immediate and definite diagnosis of gastric abscess can be made.13
Until recently, the recommended therapy for an intramural gastric abscess was gastrectomy in combination with antibiotics. Nowadays, in order to avoid unnecessary surgery, the alternative method of initial treatment by endoscopic approach is recommended, and it has been shown to be effective. In prior studies, for the noninvasive treatment of the gastric abscess, endoscopic or percutaneous drainage was introduced.4
According to a previous report from 1972 to 2003, there were only 17 reported cases of intramural gastric abscess.4 The 16 (89%) patients of a total of 18 presented with abdominal pain. The 11 cases (61%) were performed by surgery and four (22%) cases with endoscopic drainage, and two (11%) cases with percutaneous drainage, and one (6%) case with antibiotics. Several publications since 2003 were reviewed, and 15 reported cases were identified including our case (Table 1).3,4,13-22
Table 1. Clinical Presentation and Treatment of Intramural Gastric Abscess
Author (year) | Age (yr) | Sex | Symptom at presentation | Diagnostic method | Treatment | Survival |
---|---|---|---|---|---|---|
Chen | 47 | Female | Abdominal pain | CT/EUS | Surgery+antibiotics | Yes |
Chen | 31 | Male | Abdominal pain | CE/EUS | Surgery+antibiotics | No |
Jun | 60 | Female | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Odish | 75 | Female | Abdominal pain | CT/EUS | Antibiotics | Yes |
Alonso | 55 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Ota | 74 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Park | 74 | Male | Nausea | CT | Surgery | Yes |
Dohi | 63 | Female | Abdominal pain | CT | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Cole | 46 | Female | Nausea | CT | Endoscopic drainage+antibiotics | Yes |
Ergün | 11 | Male | Abdominal pain | CT | Antibiotics | Yes |
Kimura | 68 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Marcos | 48 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Kiil | 63 | Male | Esophagitis bleeding | EGD | Endoscopic drainage | Yes |
Choong | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Current study (2022) | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
CT, computed tomography; EUS, endoscopic ultrasonography; EGD, esophagogastroduodenoscopy.
The technical advances of endoscopic drainage procedure have emerged as an alternative to surgical approach these days. In our case, the abscess was treated with endoscopic aspiration and irrigation after endoscopic incision. First, the top of the mass was incised about 1.5 cm up to the submucosal layer by H-knife after saline injection. Then clear fluids flowed out from the opening. We used an endoscopic retrograde cholangiopancreatography catheter for the lavage of the submucosal abscess similar to a prior study.12 An endoscopic retrograde cholangiopancreatography catheter was introduced to the incisional opening, and aspiration of the fluid for the culture study was done. Finally, 20 mL of normal saline was used to irrigate the abscess pocket. After the procedure, markedly collapsed mass was observed and the symptoms of the patient improved immediately. In other reports, which did not perform an incision, a pigtail catheter was left in place for 1 month to allow for additional drainage of pus.12 This sequence of a sufficient incision, aspiration and irrigation without remaining pigtail catheter is a minimally invasive and inexpensive way to achieve the early treatment and safety, even a follow-up endoscopy is not mandatory.
To summarize, we report a rare case of gastric wall abscess with a rare pathogen, treated with minimally invasive endoscopic incision and drainage. Appropriately chosen antibiotics confirmed from the drained sample were also helpful. Because the endoscopic approach to gastric abscess is uncommon, we expect more reports, and sharing the experience of each treatment would be important.
No potential conflict of interest relevant to this article was reported.
Study concept and design: K.R.K. Data acquisition: K.R.K., K.N.S., A.R.C., M.J.L., Y.H.P., E.M.S., C.H.T., S.A.J. Drafting of the manuscript: K.R.K., K.N.S. Critical revision of the manuscript for important intellectual content: K.R.K., K.N.S. Administrative, technical, or material support; study supervision: K.N.S., A.R.C., M.J.L., Y.H.P., E.M.S., C.H.T., S.A.J. Approval of final manuscript: all authors.
Gut and Liver
Published online January 26, 2023
Copyright © Gut and Liver.
Kyung Rok Kim , Ki Nam Shim
, A Reum Choe
, Min Jong Lee
, Ye Hyun Park
, Eun Mi Song
, Chung Hyun Tae
, Sung Ae Jung
Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Correspondence to:Kyung Rok Kim
ORCID https://orcid.org/0000-0003-3778-0058
E-mail dkflak80@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gastric wall abscess is a rare condition characterized by a purulent inflammatory process resulting in the formation of a pocket of pus in the stomach. As the mucosa is usually intact, it requires various tools such as endoscopic ultrasonography or computed tomography for the differential diagnosis to rule out more common subepithelial tumors. Even after the diagnosis, the treatment for gastric wall abscess was previously restricted to surgical resection in combination with antibiotics. Currently, in order to avoid unnecessary surgery, the alternative method of initial treatment with an endoscopic approach is recommended. It also helps to choose appropriate antibiotics with confirmation of the pathogen by drainage. There are few reports that describe the detailed processing of the endoscopic drainage, and there is no consensus on the treatment. The pathogens that cause gastric wall abscess are usually Streptococci, Staphylococci, and Escherichia coli. There is only one case reported to be caused by Candida albicans. This is the first report of Elizabethkingia anopheles as the pathogen of the gastric wall abscess. Here, we report a case of gastric wall abscess in a 75-year-old man, safely treated by endoscopic drainage and antibiotics, confirmed by isolating the contents of the abscess.
Keywords: Abdominal abscess, Phlegmon, Suction drainage, Case reports
Gastric wall abscess is a rare disease and difficult to diagnose. Due to the characteristics of the abscess, it is difficult to culture and the therapeutic effect of empirical antibiotics can be restricted. Until now, most gastric abscess required surgical intervention if there was no response to empirical antibiotics. However, endoscopic approach is emerging as an alternative method. Here we report a unique case of gastric wall abscess treated by endoscopic drainage and specified antibiotics by culture results. The patient provided written informed consent for the publication.
A 75-year-old man visited a primary medical clinic, presenting with epigastric pain, anorexia, and vomiting. He had a history of hepaticojejunostomy due to calculous cholecystitis. He was referred to our hospital and admitted for further evaluation of the mass found on the abdominal ultrasound. In the initial laboratory results, the white blood cell count was 10,550/mL and C-reactive protein level was elevated to 4.25 mg/dL (normal range, <0.05 mg/dL). Computed tomography (CT) of the abdomen identified about 4 cm sized low-density mass-like lesion with peripheral enhancement which invaded the gastric antral submucosa, which was compatible with abscess (Fig. 1A). A 6.4-cm-sized large mass with multiple small nodular lesions in peripheral portion compatible with abscess was detected in the left lateral segment of the liver. Later, the mass in the liver was diagnosed as intrahepatic cholangiocarcinoma by ultrasound-guided liver biopsy and positron emission tomography/CT. Treatment for gastric abscess with empirical broad-spectrum antibiotics (intravenous [IV] ceftriaxone 2 g every 24 hours) was initiated. Despite treatment, during the first 4 hospital days, his pain did not improve and fever up to 38.8°C developed. White blood cell increased to 16,480/mL and the C-reactive protein level increased to 6.66 mg/mL, but there was no growth in the blood culture. We changed antibiotics (meropenem 1 g IV every 12 hours) and performed an esophagogastroduodenoscopy with endoscopic ultrasonography (EUS). Esophagogastroduodenoscopy showed a huge subepithelial tumor (Fig. 1B) and EUS showed about 4.3×2.5 cm sized homogenous mass with mixed echo from the third layer at the anterior wall of the antrum, which filled with liquified material, and air fluid level was noted (Fig. 1C). We performed endoscopic incision and drainage immediately. After the injection of saline (Fig. 2A), about 1.5-cm-sized incision up to the submucosal layer was done by H-knife (Clear-Cut Knife H type, Finemedix Co., Ltd., Daegu, Korea) (Fig. 2B). Clear fluids gushed out from the opening (Fig. 2C). An endoscopic retrograde cholangiopancreatography catheter was introduced to the opening to the abscess pocket, and aspiration was done for the culture studies (Fig. 2D). About 20 mL of saline irrigation into the lesion was done. After the procedure, the lesion was markedly collapsed (Fig. 2E). Over the following 3 days, dramatic improvement of epigastric pain was achieved. The culture from the drained fluid detected
An intramural gastric abscess is a localized form of phlegmonous gastritis.1 The most common manifestation of phlegmonous gastritis is the diffuse involvement of the gastric submucosa extending into all layers of the gastric wall. A localized form is relatively rare, accounting for 5% to 15% of all phlegmonous gastritis.2 A purulent inflammatory process results in the forming of a pocket of pus, usually in the antrum and pylorus, but it can develop in any location of the stomach.3 The submucosa of the involved lesion may be thickened, and the flattened mucosa almost looks intact, so we need to rule out subepithelial tumors such as gastrointestinal stromal tumors.4
As the pathogenesis of phlegmonous gastritis is unknown, the cause of the intramural gastric abscess is not certain. The possible causes are the direct bacterial invasion through the damaged gastric mucosa. Another source can be an infection by lymphatic or hematogenous dissemination.2 To the best of our knowledge, the most common pathogens are
First described in 2005,
The intramucosal gastric abscess or phlegmonous gastritis is known to be related with heavy alcoholics, immunocompromised state such as human immunodeficiency virus infection, nutrition deficiency, diabetes mellitus, chronic kidney disease, leukemia, multiple myeloma, rheumatoid arthritis, and chronic steroid use. Also, the secondary type of phlegmonous gastritis is associated with the infection of other organs, such as biliary infection or hepatic abscess.9-11 In our case, he had anorexia because of persistent vomiting and epigastric pain. Nutrition deficiency was another risk factor for poor general condition.
The protruding mass with normal-looking mucosal appearance of gastric abscess is similar to that of subepithelial tumors. CT and EUS are helpful in the diagnosis of gastric abscess. Enhanced abdominal CT shows a low-density mass with peripheral ring enhancement. A typical EUS finding is the thickening of the gastric wall with a localized hypoechoic mass, which has heterogeneously mixed echogenicity.12 EUS is superior to CT scan in measuring the contents of mass, the depth, and extent of invasion. We could notice liquified materials and air-fluid level. Even after CT and EUS, it can be confused with cancerous lesions. To avoid misdiagnosis, fine-needle aspirationis are useful and if there is any purulent fluid leakage from the lesion site, an immediate and definite diagnosis of gastric abscess can be made.13
Until recently, the recommended therapy for an intramural gastric abscess was gastrectomy in combination with antibiotics. Nowadays, in order to avoid unnecessary surgery, the alternative method of initial treatment by endoscopic approach is recommended, and it has been shown to be effective. In prior studies, for the noninvasive treatment of the gastric abscess, endoscopic or percutaneous drainage was introduced.4
According to a previous report from 1972 to 2003, there were only 17 reported cases of intramural gastric abscess.4 The 16 (89%) patients of a total of 18 presented with abdominal pain. The 11 cases (61%) were performed by surgery and four (22%) cases with endoscopic drainage, and two (11%) cases with percutaneous drainage, and one (6%) case with antibiotics. Several publications since 2003 were reviewed, and 15 reported cases were identified including our case (Table 1).3,4,13-22
Table 1 . Clinical Presentation and Treatment of Intramural Gastric Abscess.
Author (year) | Age (yr) | Sex | Symptom at presentation | Diagnostic method | Treatment | Survival |
---|---|---|---|---|---|---|
Chen | 47 | Female | Abdominal pain | CT/EUS | Surgery+antibiotics | Yes |
Chen | 31 | Male | Abdominal pain | CE/EUS | Surgery+antibiotics | No |
Jun | 60 | Female | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Odish | 75 | Female | Abdominal pain | CT/EUS | Antibiotics | Yes |
Alonso | 55 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Ota | 74 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Park | 74 | Male | Nausea | CT | Surgery | Yes |
Dohi | 63 | Female | Abdominal pain | CT | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Cole | 46 | Female | Nausea | CT | Endoscopic drainage+antibiotics | Yes |
Ergün | 11 | Male | Abdominal pain | CT | Antibiotics | Yes |
Kimura | 68 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Marcos | 48 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Kiil | 63 | Male | Esophagitis bleeding | EGD | Endoscopic drainage | Yes |
Choong | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Current study (2022) | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
CT, computed tomography; EUS, endoscopic ultrasonography; EGD, esophagogastroduodenoscopy..
The technical advances of endoscopic drainage procedure have emerged as an alternative to surgical approach these days. In our case, the abscess was treated with endoscopic aspiration and irrigation after endoscopic incision. First, the top of the mass was incised about 1.5 cm up to the submucosal layer by H-knife after saline injection. Then clear fluids flowed out from the opening. We used an endoscopic retrograde cholangiopancreatography catheter for the lavage of the submucosal abscess similar to a prior study.12 An endoscopic retrograde cholangiopancreatography catheter was introduced to the incisional opening, and aspiration of the fluid for the culture study was done. Finally, 20 mL of normal saline was used to irrigate the abscess pocket. After the procedure, markedly collapsed mass was observed and the symptoms of the patient improved immediately. In other reports, which did not perform an incision, a pigtail catheter was left in place for 1 month to allow for additional drainage of pus.12 This sequence of a sufficient incision, aspiration and irrigation without remaining pigtail catheter is a minimally invasive and inexpensive way to achieve the early treatment and safety, even a follow-up endoscopy is not mandatory.
To summarize, we report a rare case of gastric wall abscess with a rare pathogen, treated with minimally invasive endoscopic incision and drainage. Appropriately chosen antibiotics confirmed from the drained sample were also helpful. Because the endoscopic approach to gastric abscess is uncommon, we expect more reports, and sharing the experience of each treatment would be important.
No potential conflict of interest relevant to this article was reported.
Study concept and design: K.R.K. Data acquisition: K.R.K., K.N.S., A.R.C., M.J.L., Y.H.P., E.M.S., C.H.T., S.A.J. Drafting of the manuscript: K.R.K., K.N.S. Critical revision of the manuscript for important intellectual content: K.R.K., K.N.S. Administrative, technical, or material support; study supervision: K.N.S., A.R.C., M.J.L., Y.H.P., E.M.S., C.H.T., S.A.J. Approval of final manuscript: all authors.
Table 1 Clinical Presentation and Treatment of Intramural Gastric Abscess
Author (year) | Age (yr) | Sex | Symptom at presentation | Diagnostic method | Treatment | Survival |
---|---|---|---|---|---|---|
Chen | 47 | Female | Abdominal pain | CT/EUS | Surgery+antibiotics | Yes |
Chen | 31 | Male | Abdominal pain | CE/EUS | Surgery+antibiotics | No |
Jun | 60 | Female | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Odish | 75 | Female | Abdominal pain | CT/EUS | Antibiotics | Yes |
Alonso | 55 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Ota | 74 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Park | 74 | Male | Nausea | CT | Surgery | Yes |
Dohi | 63 | Female | Abdominal pain | CT | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Cole | 46 | Female | Nausea | CT | Endoscopic drainage+antibiotics | Yes |
Ergün | 11 | Male | Abdominal pain | CT | Antibiotics | Yes |
Kimura | 68 | Female | Abdominal pain | CT | Endoscopic drainage+antibiotics | Yes |
Marcos | 48 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+catheter insertion+antibiotics | Yes |
Kiil | 63 | Male | Esophagitis bleeding | EGD | Endoscopic drainage | Yes |
Choong | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
Current study (2022) | 75 | Male | Abdominal pain | CT/EUS | Endoscopic drainage+antibiotics | Yes |
CT, computed tomography; EUS, endoscopic ultrasonography; EGD, esophagogastroduodenoscopy.