Abscess In Crohn Research Articles

Could ultrasound alone substitute MR imaging in evaluation of Crohn’s disease complications?

BackgroundCrohn’s disease is a chronic disease that causes remitting and relapsing inflammatory episodes in the transmural part of the gastrointestinal system. It usually affects young people. The study sought to establish whether ultrasound can visualize important/useful diagnostic features and complications of the disease in the same way that MR enterography (MRE) can. The study is a prospective cohort of 133 patients of various disease stages (active and in remission) who had previously been seen by a gastroenterologist. All patients underwent abdominal and pelvic ultrasound examinations, with each of the five intestine segments checked independently for thickening and active inflammation. Complications of fistulas, abscesses, and stenosis were evaluated. Findings at MRE together with ileocolonoscopic results were deemed the standard reference.ResultsUltrasound showed wall stenosis ranging from 5 to 12 mm, with a mean ± SD of 7.73 ± 2.30. A single loop was present in 69.2% of cases. The ileum was the most heavily involved loop portion (66.7%). In 72.9% of patients, stenosis and dilatation were present, whereas 69.7% showed active inflammation. Complications such as fistulas and abscess formation (21.2%) were identified. Ultrasound was found to be an effective tool for detecting stenosis and dilatation in the examined patients, with sensitivity of 84% and 87%, and specificity of 91% and 97%, respectively. A high accuracy of 90.9% was demonstrated for abscess formation.ConclusionsUltrasound is a noninvasive method that is comparable to MRI for detecting damaged bowel segments and transmural complications such as bowel strictures, fistulas, and abscesses in Crohn’s disease patients. However, MR imaging is more comprehensive in providing detailed information about the disease's extent and activity.

Oral vs Intravenous Discharge Antibiotic Regimens in the Management of Intra-abdominal Abscesses in Penetrating Crohn's Disease.

Antibiotics are a cornerstone in management of intra-abdominal abscesses in Crohn's disease (CD). Yet, the optimal route of antibiotic administration is poorly studied. We aimed to compare surgical and nonsurgical readmission outcomes for patients hospitalized for intra-abdominal abscesses from CD discharged on oral (PO) or intravenous (IV) antibiotics. Data for patients with CD hospitalized for an intra-abdominal abscess were obtained from 3 institutions from January 2010 to December 2020. Baseline patient characteristics were obtained. Primary outcomes of interest included need for surgery and hospital readmission within 1 year from hospital discharge. We used multivariable logistic regression models and Cox regression analysis to adjust for abscess size, history of prior surgery, history of penetrating disease, and age. We identified 99 patients discharged on antibiotics (PO = 74, IV = 25). Readmissions related to CD at 12 months were less likely in the IV group (40% vs 77% PO, P = .01), with the IV group demonstrating a decreased risk for nonsurgical readmissions over time (hazard ratio, 0.376; 95% confidence interval, 0.176-0.802). Requirement for surgery was similar between the groups. There were no differences in time to surgery between groups. In this retrospective, multicenter cohort of CD patients with intra-abdominal abscess, surgical outcomes were similar between patients receiving PO vs IV antibiotics at discharge. Patients treated with IV antibiotics demonstrated a decreased risk for nonsurgical readmission. Further prospective trials are needed to better delineate optimal route of antibiotic administration in patients with penetrating CD.

Long-Term Efficacy Analysis of Exclusive Enteral Nutrition for the Treatment of Abdominal Abscess in Crohn’s Disease

Objective: The objective is to explore the long-term efficacy of total enteral nutrition in the treatment of abdominal abscess in Crohn’s disease. Methods: Patients treated with EEN in our hospital and whose abdominal abscess disappeared after 12 weeks of treatment were included, and the data of abscess recurrence and surgical treatment during follow-up were included. Results: A total of 44 consecutive cases meeting the criteria were included. The 1-year and 2-year recurrence rates were 22.5% and 39.9% respectively. Among the patients with recurrence, 10 patients chose EEN treatment again, and 5 patients received direct surgical treatment. Of the patients who chose to undergo EEN treatment again, 8 still eventually required surgery. The 1-year operative rate was 16.9%, and the 2-year operative rate was 35.6%. The median operative time was 33.3 (95% CI: 21.3, 45.4) months. Conclusions: The 2-year cumulative incidence of recurrence of abdominal abscess in CD patients whose abdominal abscess disappeared after EEN was 39.9%, and the 2-year cumulative surgical rate was 35.6%. The operative stomy rate decreased after EEN, and the primary anastomosis rate increased significantly.

Percutaneous abdomino-pelvic abscess drainage in complicated Crohn’s disease

Purpose: Percutaneous abscess drainage (PAD) is the first-line approach for abscess in Crohn’s disease (CD) since it procrastinates or avoids surgery especially in postoperative abscesses [within 30 days post-operative (p.o.)]. We retrospectively evaluated the effectiveness, complications and outcome after PAD in postoperative and spontaneous abscesses and factors influencing the outcomes. Methods: We performed PAD in 91 abscesses, 45 (49,5%) postoperative and 46 (50,5%) spontaneous. We defined the overall success (OS) as clinical (CS) and technical success (TS) when imaging documented the resolution of the abscess with no surgery within 30 days. Conversely, patients without abscess at the time of surgery, were considered as TS but clinical failure (CF). We also analyzed the overall failure (OF) defined as CF with or without technical failure (TF). Overall technical success (OTS) was OS plus TS. Complications were classified as major and minor according to the Interventional Radiology Criteria. Results: In postoperative abscesses we found 91% OS, 9% OF, no TF and 100% OTS. In spontaneous abscesses we found 33% OS, 67% OF, 6.4% TF, 95,6% OTS. A total abscess resolution was achieved in 97,8% of patients. No major complication occurred; only 1 case of minor complication. Factors statistically influencing the outcome were postoperative vs spontaneous collections (OF: 9% vs. 67%, p < 0.0001), multiloculated vs uniloculated collections (OF: 38% vs. 1%, p < 0.0001) and upper abdominal vs lower location (OF: 13% vs. 25%, p <0.05). Conclusion: Our data confirms the safety and effectiveness of PAD even in cases needing surgery within 30 days; most remarkable, PAD allows avoidance of early reoperation in almost all the patients with postoperative abscess.

S2312 Management Dilemmas of an Intra-Abdominal Abscess in Crohn’s Disease

INTRODUCTION: Intra-abdominal abscess is a common complication affecting 10-28% of patients with Crohn’s disease. Abscesses often affect the peritoneum and the retroperitoneum. These abscesses are often formed spontaneously by fistula, hematologic seeding, or with surgical intervention. CASE DESCRIPTION/METHODS: An 18-year-old male with Crohn’s disease presents with fever, right hip pain, and increasing loose stools. CT abdomen showed active colitis involving the cecum, ascending colon and distal ileum. There was also fistulization from the ascending colon or terminal ileum to an irregular right-sided iliopsoas abscess which measured approximately 6.6 × 4.9 × 4.3 cm. A percutaneous drainage (PD) catheter was placed into the abscess and he was managed with antibiotics and steroids. He was discharged with the drain in place due to high volume output. About three weeks later, patient was found to be septic with increasing purulent drainage and pain in the drain site. Repeat CT abdomen showed almost complete resolution of abscess but minimally improved mural thickening of the terminal ileum, cecum and proximal ascending colon as well as extensive phlegmonous changes in the iliopsoas muscle. He was again treated and discharged on antibiotics and steroids. In the outpatient IBD clinic, steroids were tapered and he was started on infliximab 5 mg/kg monotherapy with proactive therapeutic drug monitoring. His drain was removed after he had minimal output and a fistulogram without persistent abscess or fistula. His infliximab was increased to 10 mg/kg every 6 weeks after being sub-therapeutic week 10. DISCUSSION: Crohn’s disease complicated by intra-abdominal abscess presents two management dilemmas. First, is the method for drainage of the abscess. Traditionally, abscesses were treated with early surgical intervention. Currently, initial PD is favored as it allows for either avoidance of surgery and it decreases the likelihood of a multi-stage surgery. PD is successful in 74-100% of cases, although 8-20% will need more than one drainage. The second dilemma is the use of immunosuppression to treat active Crohn’s disease which could theoretically worsen the abscess. This has not been well studied but in a case series, 55% of patients had abscess resolution and were able to avoid surgery when treated with both high-dose steroids and antibiotics. Some experts favor initiation of anti-TNF therapy immediately after PD placement, while others wait for complete drainage of the abscess.Figure 1.: Original irregular right-sided iliopsoas abscess measuring 6.6 × 4.9 × 4.3 cm.Figure 2.: Resolution of iliopsoas abscess with drainage catheter in place. Continued mural thickening of bowel wall.

P161 Intra-abdominal abscess in Crohn’s disease

Abstract Background Crohn’s disease (CD) is associated with the emergence of complications, including intra-abdominal abscess. Management is multidisciplinary based on close medical-surgical collaboration. The aim of the study was to evaluate the clinical characteristics, the efficacy of different therapeutic options of intra-abdominal abscess in CD patients and to identify predictive factors of a favorable response. Methods Medical records of 56 CD patients who had intra-abdominal abscess were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and therapeutic data were retrospectively assessed. Treatment progression was appreciated.IBM SPSS software 21.0 was used for statistical analysis of our data. Results In total, 897 patients were identified as having CD in the study period, 56 of them developed intra-abdominal abscess. Means that the prevalence of intra-abdominal abscess in CD patients was 6,2%. Mean age was 35,24 ± 11,6 years old with a sex ratio M/F 0,64. 47,3% had penetrating CD. 50.9% of our patients were known to be carriers of Crohn’s disease, 45% of whom were on 5-ASA, while the remaining patients 49.1% (n = 26), the abscess was inaugural and revealing of the CD.The clinical signs were dominated by pain in 80%, the abscess was localised mainly at the right iliac fossa in 77.7% of cases. Median size of collection was 3,8 ± 2 cm. There were 47,3% patients who had fistula associated to abscess. The initial reactive C protein ranged from 14 to 320 (median 58.3) mg/L. All patients had first-line treatment based on broad-spectrum bi-antibiotic therapy, alone in 25.5%, combined with surgical resection in 45.5%, surgical abscess drainage without resection in 23,6% or guided by imaging in 5.5%, the initial success was 71.7%. 28.3% of patients underwent surgery for initial treatment failure, which was dominated by ileocecal resection in 53.1%. Overall success was 92.3%, only one death was noted following postoperative release with peritonitis. Predictive factor of favorable response was: fistula associated with intra-abdominal abscess (p =0.03) and surgical resection seems to be the best therapeutic option (p < 0,001). Conclusion Intra-abdominal abscess is a complication of Crohn’s disease (CD) mainly penetrating, in almost half of the cases, it can reveal CD. Our study showed that the presence of fistula appears to be significantly associated with therapeutic success and the best results are obtained in the case of surgical resection.

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

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.

Persistent Iliopsoas Abscess Due to Fistulizing Crohnʼs Disease: Can Biologic Agents Play a Role?

Iliopsoas abscesses are a rare yet fatal complication of Crohn's Disease with an incidence of 0.4% to 4.3% and morality rate of almost 100% in untreated cases. Treatment currently relies on antibiotics and procedural intervention for refractory cases. We present an intriguing case of a persistent iliopsoas abscess resistant to antibiotics and percutaneous drainage, but responsive to combination of biologics induction therapy and surgery. A 20-year-old male with Crohn's Disease presented to the hospital with fevers, right-sided hip pain, and malaise. White blood cell count was 17.45 K/uL (ref: 4.0-10.80 K/uL), C-reactive protein 45 mg/L (ref: 0-5 mg/L), and sedimentation rate was 42 mm/hour (ref: 0-15 mm/hour). Contrast enhanced computed tomography (CT) revealed a 5 X 3 cm abscess along the medial aspect of the right iliopsoas muscle and incidental ipsilateral hydroureteronephrosis (Image 1). Patient underwent CT-guided right iliopsoas percutaneous drain placement. He was empirically started on ceftriaxone and metronidazole but fluid cultures grew Pseudomonas aeruginosa. He continued to remain febrile despite being switched to piperacillin-tazobactam and later, meropenem. Patient subsequently underwent exploratory laparotomy with ileocecectomy and primary anastomosis for 45 cm of diseased terminal ileum. He remained hemodynamically stable and was discharged. Four weeks post-operatively, he was started on combination infliximab and methotrexate induction therapy with good response. Repeat CT for surgical follow-up showed marked improvement in the right iliopsoas abscess (Image 2). Crohn's Disease is the most common cause of secondary iliopsoas abscesses. Terminal ileum disease can cause iliopsoas abscesses by direct extension of a sinus tract through the mesentery into the retroperitoneal space overlying the iliopsoas sheath. Hydroureteronephrosis and deep vein thrombosis may occur due to mass effect. Patients must be promptly started on broad-spectrum antibiotics targeting anaerobes and gram-negative bacilli. CT-guided percutaneous drainage is the procedure of choice, requiring surgical intervention only in refractory cases. Our patient remained febrile despite broad-spectrum antibiotics and percutaneous drainage, making him the ideal candidate for surgical resection in combination with starting biologic agents. The role of biologics in mitigating the progression of persistent iliopsoas abscesses in Crohn's Disease needs to be explored further.2097_A Figure 1. 5 x 3 cm iliopsoas abscess with ipsilateral hydroureteronephrosis2097_B Figure 2. Improvement in abscess with biologic therapy and surgery

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

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.

Safety and Efficacy of Exclusive Enteral Nutrition for Percutaneously Undrainable Abdominal Abscesses in Crohn's Disease.

Background The percutaneously undrainable abdominal abscesses in Crohn's disease (CD) are not uncommon. The treatment protocol is still under debate. This study was conducted to assess the safety and efficacy of exclusive enteral nutrition (EEN) for percutaneously undrainable abscesses in CD. Methods A consecutive cohort of 83 CD patients with percutaneously undrainable abdominal abscesses between January 2011 and June 2015 was retrospectively analyzed. They were divided into the EEN group and the non-EEN group. Results The cumulative surgical rate was significantly lower in the EEN group than in the non-EEN group (P = 0.001). Fifteen percent patients treated with EEN avoided surgery. EEN (P = 0.002) was associated with a decreased need for surgery. Previous abdominal surgery (P = 0.009) and abscess diameter > 3 cm (P = 0.022) were associated with an increased need for operation. EEN increased the albumin level, while decreased ESR and CRP significantly for patients requiring surgery. The risk of postoperative intra-abdominal septic complications (P = 0.036) was significantly lower in the EEN group compared with the non-EEN group. Conclusions EEN is feasible in CD patients presenting with percutaneously undrainable abdominal abscesses. It is associated with a reduction in surgical rate, optimized preoperative condition, and improved postoperative outcomes in these specific groups of patients.

Current management of spontaneous intra-abdominal abscess in Crohn's disease

Crohn's disease (CD) is a chronic transmural disease process with approximately 10% of patients developing spontaneous intra-abdominal abscess during the first 5 years after the diagnosis. The symptoms are often nonspecific. The treatment modalities include the use of wide-spectrum antibiotics, imaging-guided percutaneous drainage (PD) and surgical drainage with or without resection. The best initial treatment strategy has not been settled controversial, as there are only retrospective studies with small sample sizes available in the literature. The majority of the patients would eventually need surgery. However a highly selected patient population with small abscess in the absence of fistulas or bowel strictures, especially those naive to immunomodulators or biologics, may respond to medical treatment alone with wide-spectrum antibiotics. The increased use of PD drainage in the last few years has been shown to reduce postoperative morbidities and risk of fecal diversion, allowing for subsequent elective surgery. Varied success rates of PD drainage have been reported in the literature. The initial surgical intervention of CD-related spontaneous abdominal sepsis is mandatory in patients with diffuse peritonitis due to free perforation. Surgery is also indicated in those with failed initial medical treatment and/or PD. This review article was aimed to evaluate the treatment modalities for spontaneous intra-abdominal abscess in CD patients and propose an algorithm for the best management of this complication.

Sterile Seroma after Drainage of Purulent Muscle Abscess in Crohn's Disease: Two Cases.

Purulent skeletal muscle abscesses can occur in Crohn's disease. We report a case of a sterile seroma complicating percutaneous drainage of a purulent skeletal muscle abscess in Crohn's ileitis. We compare and contrast this case with a similar case we published earlier. We emphasize the importance of recognition and differentiation from a septic purulent abscess.

Abdominal Abscess in Crohn's Disease: Multidisciplinary Management

Crohn's disease (CD) is characterized by full-thickness inflammation of the bowel. For this reason, perforating complications such as intra-abdominal abscesses or fistulas are common. A concomitant intra-abdominal abscess with active CD of the small bowel is a challenging dilemma for gastroenterologists and surgeons. Since there is active and severe disease, this should be treated with immunosuppressive drugs. However, in the presence of an intra-abdominal abscess, immunosuppression can be dangerous. There are several treatment options for intra-abdominal abscesses in CD. Nowadays, the first-line treatment is antibiotic therapy with or without percutaneous drainage. Historically, patients were treated with surgical drainage. With the development of percutaneous drainage, treatment shifted to a more nonsurgical approach. Success rates for percutaneous drainage in the literature vary from 74 to 100%, and it is considered to be a relatively safe procedure. It has been reported that surgery can be avoided after successful percutaneous drainage in a variable number of patients (14-85%). If sepsis is controlled, CD medication should be started to prevent recurrence. It is important to monitor the effect upon CD lesions to avoid further perforating complications. Finally, an undrainable or small abscess can be treated with antibiotics alone, although high recurrence rates have been described with this approach. Patients with a concomitant stenosis, an enterocutaneous fistula or refractory active disease are likely to require surgery. Percutaneous drainage in combination with delayed surgery is useful to improve the patient's condition prior to surgery and is associated with less morbidity, a lower stoma rate and more limited resection. In conclusion, when feasible, percutaneous drainage and antibiotics should be the treatment of choice in patients with an intra-abdominal abscess in CD. If surgery is inevitable, this must be delayed to reduce postoperative septic complications and high stoma rates.

Risk and Management of Intra-Abdominal Abscess in Crohn's Disease Treated with Infliximab

Background and Aims: Infliximab (IFX) is a monoclonal antibody used to treat patients with Crohn's disease (CD). Intra-abdominal abscess formation is a major complication of CD with negative effects on patient prognosis. We have analyzed risk factors for abscess formation in CD patients treated with IFX. Methods: CD patients who received IFX between January 2000 and April 2011 at Keio University Hospital were analyzed retrospectively. Risk factors for abscess formation were assessed by univariate and multivariate logistic regression analyses. Results: Intra-abdominal abscess was seen in 15 of 258 patients. Univariate analyses showed serum C-reactive protein (CRP) concentration at 14 weeks after initiation of IFX (p = 0.021), serum albumin concentration at week 0 (p = 0.022) and week 14 (p = 0.004), the presence of anal lesions (p = 0.036), progression of intestine deformation (p = 0.015) and early loss of response to IFX (p < 0.0001) to be risk factors. Multivariate analysis showed that CRP concentration at 14 weeks [odds ratio (OR) 1.361] and loss of IFX response within 6 months (OR 5.361) were independent risk factors. Conclusions: Abscess formation should be suspected in patients with symptoms of CD recurrence during IFX therapy. Uncontrolled CRP concentration and early loss of response to IFX are risk factors.

Comparative Outcomes of Trocar Puncture With Sump Drain, Percutaneous Drainage, and Surgical Drainage in the Management of Intra-abdominal Abscesses in Crohn’s Disease

Intra-abdominal abscess is a common complication in Crohn's disease (CD). Traditional percutaneous catheter drainage (PCD) and surgical intervention could not obtain satisfactory results in some cases. We herein demonstrate a novel management option and compare it with traditional strategies. A total of 77 patients were retrospectively collected into 3 groups. Postoperative complication, postoperative recurrence of abscess, subsequent surgery, ultimate stoma creation rate, and survival rate were analyzed. Patients were divided into the trocar group (n = 21), PCD group (n = 25), and surgery group (n = 31). The incidences of postoperative complication as well as the incidence of recurrent abscess were lowest in trocar group, and ultimate stoma creation rate was highest in the surgery group. Subsequent surgery after initial intervention and survival rate during the follow-up period were similar among the 3 groups. Trocar puncture with sump drain had lower incidence of postoperative complication, postoperative recurrence of abscess, and ultimate stoma creation compared with conventional PCD and surgical interventions. This novel technique might be an optimal option in the management of intra-abdominal abscesses in CD.

Rhinogenic metastatic brain and spinal cord abscesses in Crohn's disease

Intracranial suppurative complications from neglected rhinoenic sinusitis in the developed world are an uncommon ccurrence. However, the increased use of immune suppressive herapy and patients with chronic inflammatory, immunosuprsessive disorders, has exposed patients to an increased risk of nfectious complications with the potential for unusual clinical resentations. Patients with inflammatory bowel disease are suseptible to infectious complications and more so in the presence of mmunosuppressive therapy. We report an interesting complicaion of multifocal central nervous and peripheral abscesses due to hinogenic sinusitis in a patient with Crohn’s disease.

Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions

AimTo evaluate the diagnostic accuracy of the contrast-enhanced ultrasound (CEUS) to differentiate between intra-abdominal phlegmon and abscess. MethodsWe retrospectively reviewed all contrast-enhanced ultrasound performed between June 2006 and May 2012 to identify patients with the terms “inflammatory mass”, “phlegmon” or “abscess” on the sonographic report. The initial CEUS report was used for the diagnosis of phlegmon or abscess. Results71 inflammatory masses in 50 patients were identified in CEUS examination. 57 masses, 21 phlegmons and 36 abscesses, were confirmed by other imaging techniques, percutaneous drainage or surgery. CEUS specificity for the diagnosis of abscess was 100%. Kappa coefficient between CEUS and other techniques in the diagnosis of phlegmon or abscess was excellent (kappa=0.972). Only in one patient surgery detected a small abscess (<2cm) within a phlegmon that not was detected by CEUS. Statistically significant differences were found between the size of the abscesses before and after contrast agent injection. The interobserver agreement in the diagnosis of phlegmon or abscess was excellent (kappa=0.953). ConclusionsCEUS is an accurate method for differentiating between intra-abdominal phlegmon and abscess in gastrointestinal conditions, especially in CD. Its use may help to better define the size of the collections and avoid other techniques that use ionizing radiation. CEUS should be used to confirm an inflammatory mass identified at US.

Treatment of Intra-Abdominal Abscesses in Crohn’s Disease: A Nationwide Analysis of Patterns and Outcomes of Care

Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single-center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses. We identified all adult CD-related non-elective hospitalizations from the Nationwide Inpatient Sample 2007 that were complicated by an intra-abdominal abscess. Treatment modality was categorized into 3 strata-medical treatment alone, percutaneous drainage, and surgery. We analyzed the nationwide patterns in the treatment and outcomes of each treatment modality and examined for patient demographic, disease, or hospital-related disparities in treatment and outcome. There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD. Approximately 39 % were treated by medical treatment alone, 29 % with percutaneous drainage, and 32 % with surgery with a significant increase in the use of percutaneous drainage since 1998 (7 %). Comorbidity burden, admission to a teaching hospital, and complicated Crohn's disease (fistulae, stricture) were associated with non-medical treatment. Use of percutaneous drainage was more common in teaching hospitals. Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days, respectively, and early intervention was associated with significantly shorter hospitalization. We describe the nationwide pattern in the treatment of abdominal abscesses and demonstrate an increase in the use of percutaneous drainage for the treatment of this subgroup. Early treatment intervention was predictive of shorter hospitalization.

Resection of a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment: a case report

IntroductionA liver abscess in Crohn’s disease is a rare but important entity that is associated with a poor prognosis and high mortality when treatment is delayed. We report a case of successful liver segmentectomy for a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment.Case presentationA 31-year-old Japanese man, who had been treated with infliximab infusions for Crohn’s disease, was referred to our hospital presenting with an abrupt onset of high fever and an elevated white blood cell count and serum C-reactive protein level. Computed tomography revealed a liver abscess occupying segment 8. The limited effect of percutaneous transhepatic abscess drainage and antibiotics led us to perform radical resection of the abscess. The patient recovered quickly after surgery and the postoperative course was uneventful.ConclusionThe present case suggests that surgical removal of an abscess should be considered for patients under immunosuppression or refractory to conventional treatment.

Mo1692 Short-Term Outcomes of Percutaneous Versus Surgical Treatment of Abdominal Abscesses in Crohn's Disease - a Nationwide Study

Introduction: Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses. Methods: We identified all adult CD related hospitalizations from the Nationwide Inpatient Sample 2007, the largest allpayer hospitalization database in the United States comprising over 1000 hospitals from 40 states. Intra-abdominal abscesses were identified from all non-elective admissions. Using administrative codes, treatment modality was categorized into 3 strata medical treatment alone, percutaneous drainage (perc), and surgical treatment (surg). We examined the impact of treatment modality on length of stay, hospitalization charges, and need for total parenteral nutrition (TPN) and stoma creation. Results: There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD (mean age 41 years, 44%women). Approximately 39% were treated by medical treatment alone, 29% with percutaneous drainage, and 32% with surgery (Figure 1). The factors predictive of interventional treatment (perc or surg) were malnutrition (OR 2.4, 95%CI 1.3-4.5), and admission to a teaching hospital (OR 2.1, 95%CI 1.4-3.0). Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days respectively. Early percutaneous drainage (< 2 days) was associated with shorter hospitalizations (-8 days, 95%CI -11 to -5 days) and lower need for TPN (OR 0.45, 95%CI 0.20 1.04) (Figure 2). 27% of patients treated with surgery required creation of a temporary or permanent stoma. Compared to percutaneous drainage, surgical treatment was associated with longer hospitalizations (3.3 days, 95%CI 1.1-5.4 days), and greater hospitalizations costs ($34,314) Conclusion: We describe, for the first time, a nationwide pattern in the treatment of abdominal abscesses. Percutaneous drainage is associated with shorter length of hospital stay and lower hospitalization costs than surgical treatment. Early treatment (either percutaneous or surgical) is predictive of shorter hospitalization.