Drainage of abdominal abscesses in patients with Crohn`s disease

Abstract

Introduction: Crohn`s disease is an inflammatory bowel disease which can affect any part of the gastrointestinal tract. It is characterized with intramural inflammation of the bowel wall. This leads to the formation of ulcers and fistulas. A further complication can be the formation of intra-abdominal abscesses. Such patients are most frequently treated via open surgery. However, with the development of percutaneous drainage for intra-abdominal abscesses a less invasive method is now available. As a result, open surgery can be delayed or avoided by using this minimally invasive method combined with antibiotic therapy. Materials and Methods: There are two patients in this case series - a 35-year-old male diagnosed with Crohn`s disease in 2010 and an 18-year-old male diagnosed in 2013. During the course of their condition they developed intra-abdominal abscesses. They were drained by inserting a 10 Fr catheter using the Seldinger technique under computed tomography control. This is a minimally invasive method which is quick, with a low risk for the patient, less expensive than open surgery and does not require prolonged hospitalization. Results: Drainage of the abscesses and antibiotic treatment allowed the bowel wall to heal and recover from the inflammation. After the successful drainage the catheters were removed without complications. There was no need for an open surgery intervention. Conclusions: Intra-abdominal abscesses due to active Crohn`s disease are challenging to treat successfully for both gastroenterologists and surgeons. Percutaneous drainage in combination with antibiotics should be the treatment of choice if the size and location of the cavity allows for it. If surgery is inevitable, then it must be delayed to lower the chance for any postoperative septic complications and to lower stoma rates.