Similar Outcomes of Surgical and Medical Treatment of Intra-abdominal Abscesses in Patients With Crohn's Disease

Douglas L. Nguyen, William J. Sandborn, Edward V. Loftus, David W. Larson, Joel G. Fletcher, Brenda Becker, Jay Mandrekar, William S. Harmsen, David H. Bruining

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Background & Aims: It is not clear whether medical therapy, surgery, or both is the best approach for patients with Crohn's disease who develop an intra-abdominal abscess. Methods: We evaluated data from patients with Crohn's disease who were diagnosed with a radiologically confirmed abdominal abscess (enhancing fluid collection, ≥1 cm) from 1999 to 2006 (n = 95; median age, 42.0 y; 50.5% female). Medical/nonsurgical methods (percutaneous aspiration ± drain placement) were used for 55 patients (mean abscess size, 6.9 ± 3.2 cm), and 40 patients underwent surgical interventions (laparotomy ± bowel resection; mean abscess size, 7.5 ± 3.7 cm). We investigated risk factors for abscess recurrence. Results: The median length of hospitalization was 15.5 days for patients who underwent surgery and 5.0 days for patients who did not (P < .001). The 5-year cumulative probability of abscess recurrence was 31.2% among patients who did not undergo surgery and 20.3% among those who did (P = .25). Histories of perianal or active ileal disease predicted abscess recurrence. Initiation of pharmacologic therapy after drainage reduced the risk for abscess recurrence (P < .001). Anti-tumor necrosis factor therapy, compared with no therapy, reduced the risk of abscess recurrence (P = .001) in all patients, whereas immunosuppressive monotherapy, compared with no therapy, had a trend toward significant risk reduction (P = .06). Conclusions: Among patients with Crohn's disease who have intra-abdominal abscesses, nonsurgical and primary surgical management strategies result in similar rates of abscess recurrence and complications. Initiation of anti-tumor necrosis factor and/or immunosuppressive therapy when abscesses resolve might protect against intra-abdominal penetrating disease.

Original languageEnglish (US)
Pages (from-to)400-404
Number of pages5
JournalClinical Gastroenterology and Hepatology
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2012

    Fingerprint

Keywords

  • Anti-TNF therapy
  • IBD
  • Inflammatory bowel disease
  • Management

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this