P534 Spontaneous intra-abdominal abscess in Crohn's disease: Efficacy of non-surgical management and prognostic factors

Abstract

Spontaneous intra-abdominal abscess may complicate Crohn’s disease (CD). Management is multidisciplinary and may include antibiotics alone or associated with percutaneous drainage or surgery. The aim of the study was to evaluate efficacy of non-surgical management of intra-abdominal abscess in CD patients and to identify predictive factors of a favourable response. Medical records of CD patients who have been admitted for intra-abdominal abscess between January 2002 and October 2017 were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and radiological (CT scan or magnetic resonance imaging) response to non-surgical management of intra-abdominal abscess were retrospectively assessed. Fifty patients were included in the study. Mean age was 32 ± 11 years old. Abscess was unilocular in 32 (64%) patients, multilocular in 10 (20%) patients and multiple in 8 (16%) patients. Median size of collection was 34 ± 41 mm. There were 36 (72%) patients who had ileal fistula. Antibiotics were prescribed in all patients during 21 ± 7 days. Imaging guided percutaneous drainage was associated in 5 (10%) patients. Radiological control was performed after a median antibiotic treatment period of 21 ± 7 days. It showed complete regression of abscess in 23 (46%) patients, partial regression in 3 (6%) patients and persistence of abscess in 21 (42%) patients. Twenty-five (50%) patients underwent surgery for medical treatment failure in 21(42%) patients, peritonitis in 1 (2%) patient and intestinal obstruction in 2 (4%) patients. Predictive factors of favourable response to non-surgical management were : percutaneous drainage (p = 0.02), absence of ileal fistula (p = 0.047), unilocular type of abscess (p = 0.043) and more than 1.5 fold decrease of serum CRP level during the first 10 days of treatment (p = 0.01). Non-surgical management of spontaneous abscess complicating a CD was effective in approximately half of patients in our series. Percutaneaous drainage, unilocular type of abscess, absence of ileal fistula and significant drop of serum CRP level are predictive of favourable outcome.