A case of pericecal abscess treated successfully by endoscopic abscess drainage

A 59-year-old woman with complaint of a right lower abdominal pain and rebound tenderness was admitted to our hospital. Ultrasonography showed a 5 cm-hypoechoic lesion at the ileocecal area, which was shown as a low-density lesion with peripheral enhancement by CT scan. Even though she had rebound tenderness on admission, by the conservative therapy with Cefmetazone, abdominal sign was disappeared in a few days. For further investigation, she underwent colonoscopy, which revealed a SMT-like mucosal elevation filled with pus in the cecum apart from the orifice of the appendix. So the pericecal abscess was diagnosed. Although drainage of pericecal abscesses, usually require the ultrasound, CT guidance or laparotomy, we drained it and washed inside of the cavity colonoscopically using a catheter without complication. Bacterial culture detected Proteus. spp and E. coli from the white pus drained. After drainage of the abscess, levels of inflammatory markers further declined and colonoscopy detected no particular change in the cecum. For two years after the drainage she had no recurrence of abscesses in the pelvis. This case shows usefulness of colonoscopy and successive endoscopic abscess drainage before considering of laparotomy as the treatment of the intrapelvic pericecal abscesses.