Trocar Puncture With a Sump Drain for Crohn's Disease With Intra-Abdominal Abscess: A 10-Year Retrospective Cohort Study

Juanhan Liu,Wenbin Gong,Peizhao Liu,Guosheng Gu,Xiuwen Wu,Yun Zhao,Huajian Ren,Yangguang Li,Zhiwu Hong,Jianan Ren,Gefei Wang,Tao Zheng

doi:10.3389/fsurg.2022.816245

Abstract

BackgroundTraditional percutaneous catheter drainage (PCD) and surgical intervention could not always achieve satisfactory results for patients with Crohn's disease (CD) who have complications with intra-abdominal abscess. We proposed a trocar puncture with sump drainage for the treatment of CD with intra-abdominal abscess and compared it with the conventional PCD and surgical intervention.MethodsCrohn's disease patients with intra-abdominal abscess and admitted to our hospital from 2011 to 2020 were identified by reviewing the electronic medical records. We divided them into Trocar, PCD, and fecal diverting (FD) groups, according to the ways of treating an abscess. Outcomes, risk factors for abscess recurrence, and postoperative complications were compared among the three groups.ResultsA total of 69 patients were included and they were divided into Trocar (n = 18), PCD (n = 29), and FD (n = 22) groups. Four patients in the PCD group were transferred to receive the FD surgery due to the failure of initial treatment. The incidence of abscess recurrence was significantly higher in the PCD (48%) and FD (50%) groups compared to the patients using the trocar puncture with the sump drain (Trocar group) (16.7%). There were 8 patients in Trocar, 22 in PCD, and 20 s in the FD group who received enterectomy. None of the patients in the Trocar had an ultimate stoma and the incidence of postoperative complications was statistically lower [0% (Trocar) vs. 31.8% (PCD) vs. 45% (FD), P < 0.05]. The way of initial treating of the abscess was significantly correlated with the abscess recurrence and postoperative complications.ConclusionsTrocar puncture with a sump drain had a lower incidence of abscess recurrence, abdominal adhesions, postdrainage, and postoperative complications compared to the conventional PCD or surgical intervention.

Highlights

Crohn’s disease (CD) is a chronic, idiopathic inflammatory gastrointestinal disease that has an increasing incidence worldwide [1]
This study aimed to explore the outcomes of the trocar with sump drain and we compared it with the conventional percutaneous catheter drainage (PCD) and fecal diverting (FD) surgery in terms of complications after the initial treatment of abscess and definitive surgery, ultimate stoma creation, and the length of stay of patients with CD having intra-abdominal abscess
Among the remaining 69 patients, 18 patients were treated with trocar puncture, 29 used the conventional lower-diameter catheters to drain the pus, and 22 patients underwent FD with a temporary stoma

Summary

Introduction

Crohn’s disease (CD) is a chronic, idiopathic inflammatory gastrointestinal disease that has an increasing incidence worldwide [1]. In a recent meta-analysis, on comparing percutaneous catheter drainage (PCD) vs surgery as the initial treatment for CD-related intra-abdominal abscess, it was found that the PCD) had no obvious advantage over surgery on ultimate permanent ostomy requirement, the occurrence of complications, or hospital stays. Given the fact that the PCD had no distinct benefits, currently, there is no better option for treating intra-abdominal abscess in patients with CD other than the PCD. Under such a situation, up to 70% of patients cannot avoid subsequent bowel resection. Traditional percutaneous catheter drainage (PCD) and surgical intervention could not always achieve satisfactory results for patients with Crohn’s disease (CD) who have complications with intra-abdominal abscess. We proposed a trocar puncture with sump drainage for the treatment of CD with intra-abdominal abscess and compared it with the conventional PCD and surgical intervention

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