A Meta-analysis of Percutaneous Drainage Versus Surgery as the Initial Treatment of Crohn’s Disease-related Intra-abdominal Abscess

Abstract

PD can avoid surgery in up to 30% of patients presenting with spontaneous Crohn's-related intra-abdominal abscesses. However, the suggested advantages over surgery in relation to complications and length of stay were not apparent. Further studies in this area are needed.

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…However, case series from a number of centres in North America reflect a shift in management of Crohn's masses towards a more conservative approach, at least initially. These data demonstrate that some 30% of patients with a Crohn's mass can be managed nonoperatively [121]. Subsequent aggressive medial therapy may then be instituted cautiously (see Sections 2 and 3).…”

“…Current evidence would suggest that, in the presence of an abscess, surgery should be avoided as first‐line treatment to avoid unnecessary bowel resection . If surgery is indicated due to concomitant fistula or stricture, delaying intervention until percutaneous drainage has been carried out and the patient optimized from a nutritional and inflammatory perspective will lead to reduced overall length of bowel resection, incidence of complications and likelihood of stoma formation (see Section ).…”

Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess

“…In addition, bowel resection for CD can be complicated by anastomotic septic complications and new fistula formation, which may hinder the recovery process. The advantage of surgical over nonsurgical management in reducing abscess recurrence rates and complications is controversial (9)(10)(11)(12)(13)(14)(15). As the concept of "bowel-sparing" is of paramount importance in the management of CD, factors involved in the need for surgery should be further studied.…”

Draft recommendations of the russian society of pediatric gastroenterology, hepatology and nutrition on diagnosis and treatment of Crohn's disease in children

“…При БК осложненной формированием внутрибрюшного абсцесса требуется назначение антибактериальной терапии, а также проведение дренирования абсцесса или резекции пораженного участка кишки [180,181]. Дополнительно к антибиотикам и дренированию абсцесса должна быть усилена специфическая противовоспалительная терапия БК, снижена доза глюкокортикоидных гормонов, проведена оптимизация энтерального питания.…”