Giant subcutaneous abscess after percutaneous endoscopic gastrostomy.

hospital with dysphagia, which had re− sulted from multiple cerebral infarctions. A 20−Fr gastrostomy tube was inserted under endoscopic guidance. The proce− dure was uneventful, and antibiotics were not administered (l" Fig. 1). Al− though the skin around the fistula showed no clinical signs of abnormality, the patient’s abdominal pain increased. Computed tomography showed a low− density area in the left subcutaneous space (l" Fig. 2), and Enterococcus fae− cium was identified in cultures of pus from the stoma. The subcutaneous ab− scess was treated by surgical drainage and he was given sulbactam/cefopera− zone. The abscess responded well to treatment and disappeared 2 months after insertion of the percutaneous endo− scopic gastrostomy. Peristomal wound infection after inser− tion of a percutaneous endoscopic gas− trostomy is usually caused by oral bacte− ria. In the present case, however, a giant subcutaneous abscess was caused by En− terococcus faecium. The patient had un− dergone a Billroth II distal gastrectomy for the treatment of a peptic ulcer. The first explanation for the formation of this giant abscess in this patient could be that the resection of the pylorus and the lack of gastric acid might have enabled enter− obacteria to flow back into the stomach. Secondly, because the gastrectomy scar was known to be hypovascular, the pa− tient’s subcutaneous tissue could have been more susceptible to infection. Endoscopy_UCTN_Code_CPL_1AH_2AI