A 7-year-old girl presented with fever for 21 days and moderately severe, right hypochondriac, and epigastric abdominal pain for 7 days. She had a well-defined tender, cystic lump in the epigastric, left, and right hypochondriac regions. Investigations showed anemia with neutrophilic leukocytosis. Liver function tests, amylase, and lipase levels were normal. Abdominal ultrasound (US) revealed a heterogeneous hypoechoic lesion in the caudate lobe with another larger collection in the lesser sac. Contrast enhanced computed tomography (CT) scan confirmed a well-defined collection with peripherally enhancing wall, measuring 2.4 × 3.2 × 2.2 cm in the caudate lobe, communicating anteroinferiorly with a 10 × 4.3 × 4-cm collection in the lesser sac (Fig. 1a & b). Intravenous antibiotics (ceftriaxone, cloxacillin, and metronidazole) were given. A decision was made for endoscopic ultrasound (EUS)guided drainage of the abscess through a transgastric approach in view of its close proximity to the stomach. The lesser sac collection was visualized at the level of the proximal stomach using a linear-array echoendoscope (GF UE 160, Olympus Corp Ltd., Tokyo, Japan). The lesser sac was punctured using a 19-gauge EUS-aspiration needle (NA 220H/230H, Olympus Corp Ltd., Tokyo, Japan). Puncture of the abscess was confirmed by EUS and fluoroscopy, and by aspiration of pus that was sent for amoebic PCR and culture. A 0.035-in. diameter guidewire was advanced into the cavity. The fistula tract was dilated using a cystotome (6F Endo-Flex, GmBH, Voerde, Germany) followed by a radial expansion balloon (10 mm, Hurricane; Boston Scientific, Natick, MA, USA). Two 7Fr double-pigtail stents were inserted to maintain the patency of the cystogastrostomy (Fig. 1c,d). There were no intraand postprocedure complications. She became afebrile after the procedure, Analysis of the cystic fluid was positive for Entamoeba histolytica on PCR, and no other organisms were seen on microscopy or culture. There was complete resolution of the caudate lobe as well as lesser sac abscess documented by CT scan performed after a week (Fig. 1e,f). The pigtail stents were uneventfully removed endoscopically after 8 weeks. The child was asymptomatic at follow-up visit after 20 weeks, and there was no residual abscess on ultrasonography. EUS-guided drainage of liver abscess is a minimally invasive technique recently described in adults. It is particularly useful in abscesses not accessible to percutaneous drainage (PCD). Here, we describe the first case of a EUS-guided transgastric drainage of a ruptured caudate lobe amoebic liver abscess in a child. Caudate lobe abscesses are rare, but they may rupture into the peritoneum or stomach leading to complications. Moreover, these abscesses being inaccessible for PCD may require open surgical drainage. In such cases, EUS-guided drainage is an advantageous alternative, as it offers a minimally invasive, single-time internal drainage, minimal risk of bleeding, and a shorter hospital stay. There is a theoretic risk of subsequent reinfection. This is improbable, as auto-infection can occur only with encysted form of Entamoeba histolytica, but liver abscesses are populated by trophozoites that are rapidly killed by metronidazole if not by the gastric acid. Our child remains symptom-free 5 months later. Since 2005, many cases of EUS-guided liver abscess drainage have been reported in adult patients.