Current management of spontaneous intra-abdominal abscess in Crohn's disease

Abstract

Crohn's disease (CD) is a chronic transmural disease process with approximately 10% of patients developing spontaneous intra-abdominal abscess during the first 5 years after the diagnosis. The symptoms are often nonspecific. The treatment modalities include the use of wide-spectrum antibiotics, imaging-guided percutaneous drainage (PD) and surgical drainage with or without resection. The best initial treatment strategy has not been settled controversial, as there are only retrospective studies with small sample sizes available in the literature. The majority of the patients would eventually need surgery. However a highly selected patient population with small abscess in the absence of fistulas or bowel strictures, especially those naive to immunomodulators or biologics, may respond to medical treatment alone with wide-spectrum antibiotics. The increased use of PD drainage in the last few years has been shown to reduce postoperative morbidities and risk of fecal diversion, allowing for subsequent elective surgery. Varied success rates of PD drainage have been reported in the literature. The initial surgical intervention of CD-related spontaneous abdominal sepsis is mandatory in patients with diffuse peritonitis due to free perforation. Surgery is also indicated in those with failed initial medical treatment and/or PD. This review article was aimed to evaluate the treatment modalities for spontaneous intra-abdominal abscess in CD patients and propose an algorithm for the best management of this complication.

A case report on delayed diagnosis of perforated Crohn’s disease with recurrent intra-psoas abscess requiring omental patch

“…These conflicting reports found in our comprehensive literature search make a definitive conclusion about treatment difficult. A treatment algorithm recently proposed by Carvalho et al and that agrees with current American College of Radiology guidelines takes into account patients’ abscesses characteristics, medication history, and disease progression [13]. They recommend initial imaging, best performed via ultrasonography or CT, to determine the size of the abscess [14].…”

Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature

“…Only certain group of patients with cecal acute abdomen can be managed conservatively. These include certain patients with localized retrocecal abscess which can be aspirated using imaging studies,[ 51 ] typhlitis responding to medications,[ 52 ] amebic colitis with or without liver abscess,[ 3 5 ] certain cases of cecal diverticulitis,[ 53 ] and old debilitated patients in whom surgical outcome is expected to be very poor. We also managed five patients conservatively.…”

Percutaneous Image-Guided Drainage of Abdominal Fluid Collections in Children: Technical Considerations and Clinical Scenarios

“…11 PIGD should be performed for abscesses greater than 3 cm. 108,109 The dominant abscesses are percutaneously drained in patients with multiple collections, whereas smaller abscesses (<2-3 cm) usually resolve with antibiotics alone. 108,110 Successful PIGD of CD-related abscesses usually requires placement of an indwelling percutaneous catheter.…”

“…108 109 The dominant abscesses are percutaneously drained in patients with multiple collections, whereas smaller abscesses (<2–3 cm) usually resolve with antibiotics alone. 108 110 Successful PIGD of CD-related abscesses usually requires placement of an indwelling percutaneous catheter. 11 Aspiration alone without drain placement is generally inadequate, given these collections usually result from active fistulas from affected bowel.…”