Conservative management of spontaneous intra‐abdominal abscess in Crohn's disease: Outcome and prognostic factors. Issue 5 (16th April 2021)

• Record Type: Journal Article
• Authors: Waked, Bruno; Holvoet, Tom; Geldof, Jeroen; Baert, Filip; Pattyn, Piet; Lobatón, Triana; Hindryckx, Pieter
• Is Part Of: Journal of digestive diseases. Volume 22:Issue 5(2021)
• Page Start: 263
• Page End: 270
• Publication Date: 2021-04-16
• Subjects: abdominal abscess -- conservative treatment -- Crohn disease -- drainage -- general surgery; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.12984
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract : Objective: To compare the outcomes of different treatments for spontaneous intra‐abdominal abscesses (IAA) in active Crohn's disease (CD). Methods: A retrospective analysis of patients with CD between January 2007 and December 2018 was performed in two Belgian inflammatory bowel disease centers. Successful conservative management was defined as complete resolution of abscesses without the need for bowel resection. The primary outcome was suboptimal evolution, defined as a composite outcome of recurrence of abscess, postoperative complications or the need for a non‐elective resection. Results: Forty CD patients presenting with 43 independent episodes of spontaneous IAA development were included. One underwent immediate bowel resection. In all other 42 cases a conservative approach was taken, which led to a complete abscess resolution rate of 28.6% (12/42). The remaining abscesses required bowel resection. Anti‐tumor necrosis factor (TNF) agent use was associated with successful conservative management (odds ratio [OR] 13.36, 95% confidence interval [CI] 11.19‐15.52, P = 0.006), while the opposite trend was found for corticosteroids (OR 0.14, 95% CI 0.02‐1.26, P = 0.055). There was a trend towards suboptimal evolution in case of previous bowel resection (OR 4.77, 95% CI 0.77‐29.66, P = 0.094) or in patients aged above 50 years (OR 5.17, 95% CI 0.86‐30.91, P = 0.072). Conclusions: Bowel resection appears to be inevitable in most CD patients presenting with IAA. An attempt at conservative treatment may be particularly successful with anti‐TNF agents in younger patients who have not undergone previous bowel resection. Large‐scale prospective studies are needed to confirm these findings. Abstract : While the role of drainage remains unclear and bowel resection appears to be inevitable in most patients with Crohn's disease presenting with a spontaneous intra‐abdominal abscess, we found that anti‐tumor necrosis factor may be successful in younger patients without a history of previous bowel resection. As long as prospective data are lacking, a multidisciplinary approach by gastroenterologists, surgeons and interventional radiologists remains crucial.