Abscess in Crohn's disease—The knife may not be necessary (An American view)

Abstract

Abdominal and pelvic abscess complicate the clinical ourse of Crohn’s disease in 10–30% of patients [1]. In some atients it may be the presenting symptom while in others bscess may develop late in the clinical course. The classical pproach to the treatment of an abscess in Crohn’s is surical drainage. However, this is an invasive procedure and f combined with bowel resection, often complicated. Over he past two decades, medical therapy with percutaneous rainage under radiological guidance has become increasngly utilised, either as a temporising measure before surgery allowing optimisation of the general condition of the patient nd ensuring a relatively sterile field of operation). However, here are few large studies formally evaluating the outcome f this approach. The study published by Lee et al. [2] evaluates the outcome f nonsurgical treatment (medical or medical plus percutaeous catheter drainage) in the management of abdominal nd pelvic abscess associated with Crohn’s disease and the actors related to the failure of such an approach. Data from 24 onsecutive patients with abdominal and pelvic abscess were etrospectively analysed. These patients were from a single entre in Korea, a country with a low prevalence of Crohn’s isease [3]. An abscess was defined as an extraluminal fluid ollection with the characteristic radiologic features on CT r US or by aspiration of pus. Barium studies were done o evaluate for fistula. All patients received intravenous 3rd eneration cephalosporine and metronidazole for 4 weeks. t the end of the antibiotic treatment, radiologic evaluation as repeated. After a follow-up period of 47.5 months (range –79), the authors report their approach to be successful in wo-thirds of the cases, with a recurrence rate of only about 6%. Only one patient with recurrence required surgical treatent and other two responded to medical retreatment. Surgial therapy was also required for intractable abscesses (four n medical treatment and one on percutaneous drainage). he authors concluded that nonsurgical treatment should be onsidered as the initial management strategy for Crohn’s isease-related abdominal and pelvic abscess in the absence f relevant fistula and concurrent steroid use. In this regard it