Intraperitoneal abscess formation spreading to the liver after endoscopic ultrasound-guided fine-needle aspiration for abdominal lymphadenopathy

  • Koji TakahashiEmail author
  • Hiroshi Kashimura
  • Naoaki Konno
  • Miyuki Nakagawa
  • Akari Munakata
  • Ken Okawara
  • Yohei Aoki
  • Takeshi Nihei
Case Report


A 75-year-old woman was admitted to our hospital because of anemia and appetite loss. She had rheumatoid arthritis and was taking 1 mg of prednisolone and 150 mg of peficitinib orally. She was detected with lymphadenopathy, 18 mm in diameter, around the common hepatic artery with abdominal ultrasonography and abdominal computed tomography. Upper gastrointestinal endoscopy, colonoscopy, and chest computed tomography did not show any evidence of malignant disease. Using endoscopic ultrasound-guided fine-needle aspiration, the lymphadenopathy was punctured through the stomach. She was discharged 4 days after endoscopic ultrasound-guided fine needle aspiration. However, 3 days following discharge, she developed fever and was admitted again 14 days after the endoscopic ultrasound-guided fine-needle aspiration. Abdominal ultrasonography revealed that, at the site of the lymphadenopathy where the endoscopic ultrasound-guided fine-needle aspiration was performed, an intraperitoneal abscess was formed and spreading to the lateral segment of the liver, penetrating the hepatic capsule. Antibiotics failed to improve her condition. Percutaneous transhepatic abscess aspiration was performed 4 days following admission. Thereafter, her condition improved, and she was discharged 10 days after the transhepatic abscess aspiration. It should be noted that intraperitoneal abscess formation in the puncture can occur after ultrasound-guided fine-needle aspiration. Particularly in immunosuppressed patients such as our case, attention may be needed more than those with normal immune function.


Endoscopic ultrasonography Endoscopic ultrasound-guided fine needle aspiration Intraperitoneal abscess Lymphadenopathy Percutaneous transhepatic abscess aspiration 



The authors would like to thank all the staff involved in treatment of the patient at Mito Saiseikai General Hospital. We would also like to thank Enago for the English language review.

Compliance with ethical standards

Conflict of interest

Koji Takahashi, Hiroshi Kashimura, Naoaki Konno, Miyuki Nakagawa, Akari Munakata, Ken Okawara, Yohei Aoki and Takeshi Nihei declare that they have no conflict of interest.

Human/animal rights

This study does not include any data about human specimen. All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

This is a case report and does not involve human subjects and does not apply to giving informed consent.


  1. 1.
    Yasuda I, Goto N, Tsurumi H, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy for diagnosis of lymphoproliferative disorders: feasibility of immunohistological, flow cytometric, and cytogenetic assessments. Am J Gastroenterol. 2012;107:397–404.CrossRefGoogle Scholar
  2. 2.
    Polkowski M, Larghi A, Weynand B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) technical guideline. Endoscopy. 2012;44:190–206.CrossRefGoogle Scholar
  3. 3.
    Hewitt MJ, McPhail MJ, Possamai L, et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–31.CrossRefGoogle Scholar
  4. 4.
    Wang KX, Ben QW, Jin ZD, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc. 2011;73:283–90.CrossRefGoogle Scholar
  5. 5.
    Kumagai S, Muta Y, Yazumi S. Tuberculous abscess formation with liver invasion after endoscopic ultrasound-guided fine-needle aspiration for abdominal lymphadenopathy. Endoscopy. 2014;46:E188–E189.Google Scholar
  6. 6.
    Catalano MF, Sial S, Chak A, et al. EUS-guided fine needle aspiration of idiopathic abdominal masses. Gastrointest Endosc. 2002;55:854–8.CrossRefGoogle Scholar
  7. 7.
    Alkaade S, Chahla E, Levy M. Role of endoscopic ultrasound-guided fine-needle aspiration cytology, viscosity, and carcinoembryonic antigen in pancreatic cyst fluid. Endosc Ultrasound. 2015;4:299–303.CrossRefGoogle Scholar
  8. 8.
    Rana SS, Sharma V, Sharma R, et al. Gastric gastrointestinal stromal tumor mimicking cystic tumor of the pancreas: diagnosed by endoscopic ultrasound-fine-needle aspiration. Endosc Ultrasound. 2015;4:351–2.CrossRefGoogle Scholar
  9. 9.
    Baysal B, Masri OA, Eloubeidi MA, et al. The role of EUS and EUS-guided FNA in the management of subepithelial lesions of the esophagus: a large, single-center experience. Endosc Ultrasound. 2017;6:308–16.CrossRefGoogle Scholar
  10. 10.
    Parekh PJ, Majithia R, Diehl DL, et al. Endoscopic ultrasound-guided liver biopsy. Endosc Ultrasound. 2015;4:85–91.CrossRefGoogle Scholar
  11. 11.
    Zhu H, Jiang F, Zhu J, et al. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: a systematic review and meta-analysis. Dig Endosc. 2017;29:667–75.CrossRefGoogle Scholar
  12. 12.
    Kobayashi S, Ikeura T, Takaoka M. Gastric wall abscess formation after endoscopic ultrasound-guided fine-needle aspiration of pancreatic cancer. Dig Endosc. 2016;28:220.CrossRefGoogle Scholar
  13. 13.
    Ushijima T, Okabe Y, Ishida Y, et al. A case of intragastric wall abscess developing after EUS-FNA in a patient with pancreatic body cancer. Gastrointest Endosc. 2017;85:1097–8.CrossRefGoogle Scholar
  14. 14.
    Wu WQ, Du J, Yang JM, et al. A rare case of gastric wall abscess arising after endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass. Endoscopy. 2018;50:E142–E143.CrossRefGoogle Scholar
  15. 15.
    Jacobs JA, Pietersen HG, Stobberingh EE, et al. Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius. Clinical relevance, hemolytic and serologic characteristics. Am J Clin Pathol. 1995;104:547–53.CrossRefGoogle Scholar
  16. 16.
    O’Toole D, Palazzo L, Arotçarena R, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001;53:470–4.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyMito Saiseikai General HospitalMitoJapan

Personalised recommendations