EUS-Guided Transmural Drainage of a Splenic Abscess

A 35-year-old man with a history of alcohol use disorder and severe acute pancreatitis complicated by persistent pseudocyst causing splenic vein compression/thrombosis presented with recurrent GI bleeding from gastric varices and splenic vein thrombosis. EUS of the gastric varices showed innumerable small vessels not amenable to endoscopic embolization. Because of the associated pancreatic tail pseudocyst, he was deemed a non–surgical candidate for splenectomy. He underwent an EUS-guided cystgastrostomy of the pseudocyst and interventional radiologic embolization of the splenic artery.