P351 Spontaneous intra-abdominal abscesses in Crohn’s disease: The experience of a tertiary centre

Abstract

Abstract Background Crohn’s Disease (CD) is a transmural inflammatory disease with the possibility of pan-gastrointestinal involvement that could lead in 10–30% of the cases to spontaneous intra-abdominal abscesses (SIAP). Their management is multidisciplinary and personalised. Our goal was to describe the acute management of SIAP in our centre, as well the recurrence rate of abscess and the need of elective surgery. Methods We retrospectively reviewed medical records of CD patients who have been admitted for intra-abdominal abscess between April 2009 and August 2017. Patients with secondary or perianal abscesses were excluded. Results 24 patients were included in this study with a mean time of hospital stay of 22.13 days. Seventy-nine per cent were male, the mean age was 39 years and 50% were smokers. According to Montreal’s Classification: 62,5% were A2, 58,5% L1 and 75% B3 (+p in 8,3%). 9 were under immunosuppressants (IS), 5 under corticosteroid and 4 under anti-TNF(2 combo therapy). All patients were admitted at the emergency room, more frequently with abdominal pain. 20,8% had SIAP as the first manifestation of CD. The most frequent location was inner loops(mean size was 5.54 cm (0.5–13 cm)). All the patients were prescribed with antibiotics; 10 had only antibiotic; 10 also performed percutaneous drainage(PD); 3 underwent surgical drainage, and 1 suffer from spontaneous drainage by an enterocutaneous fistula. Treatment failure was seen in 1 patient of antibiotic and PD groups. 83,3% underwent exclusive enteral nutrition during the hospital stay. 36,4% started corticotherapy. During follow-up, 33,3% added anti-TNF and 15 patients underwent elective surgery ±11.1 month after the discharge. Only 1 relapse of the SIAP was identified after 8 months of discharge. No deaths due CD were observed. Conclusion Our population consisted of predominately in young males, with younger age at the diagnose of CD, with ileal involvement and under IS. 5 patients had SIAD as the first manifestation of CD. The majority of the SIAP was controlled in acute context with only 1 patient showing a recurrence of SIAP. 15 patients needed elective surgery in the follow-up period, and 33,3% escalated medical therapy. Our results regarding the need for elective surgery aren’t far from published. More studies with larger cohorts are needed highlighting the individual management of each patient.