Intra-abdominal Abscesses In Patients Research Articles

Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn's Disease Might Be Associated With Increased Rates of Stoma Construction.

Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn's disease (CD) with radiologically guided percutaneous drainage (PD) was debated. This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors.

Comparison of Microbiological Profile of Drained Intra-Abdominal Abscess in Patients with Crohn’s Disease and Colonic Diverticulitis

Comparison of Microbiological Profile of Drained Intra-Abdominal Abscess in Patients with Crohn’s Disease and Colonic Diverticulitis

Impact of postoperative NSAIDs (IV-PCA) use on short-term outcomes after laparoscopic gastrectomy for the patients of gastric cancer.

Further data are necessary to evaluate the risk of complications associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) postoperatively. This study aimed to determine the correlation between the use of NSAIDs in intravenous patient-controlled analgesia (IV-PCA) and postoperative complications after laparoscopic gastrectomy in patients with gastric cancer. This retrospective, single-center study was conducted. The study population comprised 2150 patients who underwent laparoscopic gastrectomy for gastric cancer treatment. They were divided into two groups: non-NSAIDs (n = 1215) and NSAIDs (n = 935) according to their use of the drugs. Clinicopathologic characteristics, operative details, postoperative complications within 30days, risk factors for complications, and survival were analyzed. Of the 2150 patients, 935 (43.49%) used NSAIDs. The overall complication rate showed no significant difference between the NSAIDs and non-NSAIDs groups (22.7% vs. 20.7%, p = 0.280), while the rates of anastomotic leakage and duodenal leakage were higher in the NSAID group (2.4% vs. 0.7%, p = 0.002 and 1.8% vs. 0.6%, p = 0.007, respectively). The rates of intra-abdominal bleeding and intra-abdominal abscess were significantly higher in the NSAID group (2.1% vs. 0.7%, p = 0.005 and 1.5% vs. 0.4%, p = 0.008, respectively). However, postoperative ileus occurred more frequently in the non-NSAID group (3.0% vs. 1.4%, p = 0.015). On multivariate analysis, NSAID use was an independent risk factor for early postoperative complications (1.303 [1.042-1.629], p = 0.020). Meanwhile, the NSAID group showed no differences in overall survival at each pathological stage. Postoperative NSAID use by IV-PCA is associated with anastomotic leakage, duodenal stump leakage, intra-abdominal bleeding, and intra-abdominal abscess in patients who underwent laparoscopic gastrectomy for gastric cancer. Caution is advised when NSAIDs are used peri-operatively.

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease.

BackgroundIn patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD.MethodsA multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1–14 days, 15–30 days and more than 30 days) for comparison of outcomes.ResultsThe cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24–44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6–15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042).ConclusionSmoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.

P122 Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Abstract Background Intra-abdominal abscess is an important clinical complication of Crohn’s disease (CD), which can be diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI). However, a high index of clinical suspicion is needed to diagnose an abscess as abdominal imaging is not routinely used during hospital admission. This study aimed to identify clinical predictors of an intra-abdominal abscess among hospitalized patients with CD. Methods We created an electronic data repository of all patients with CD who visited the emergency department (ED) of our tertiary medical center between 2012 and 2018. Data included tabular demographic and clinical variables, as well as CT and MRI imaging outcomes. We searched the data repository for the presence of an abscess on abdominal imaging within seven days from the ED visit. Machine learning models were trained to predict the presence of an abscess. A logistic regression model was compared to a random forest model. The area under the receiver operator curve (AUC) was used as a metric. To establish statistical significance, bootstrapping of 100 experiments with random 80/20 training/testing splits was performed. We included only patients who were hospitalized due to complaints that can be attributed to CD exacerbation. Patients presenting within 30 days from an abdominal surgery were excluded. Results Overall, 1556 patients with CD visited the ED, of those 555 patients with a CD exacerbation. Of them, 339 patients were hospitalized and underwent abdominal imaging within 7 days from the ED visit. Forty-two patients (12.1%) were diagnosed with an abscess on abdominal imaging. The average length of the abscess was 32 mm (IQR 21.5, 43.5), mainly in the mesentery adjacent to the small bowel (38.1%). On multivariate analysis, high CRP values (64.97 mg/L, aOR 14.42 [95% CI 4.93–42.13]), high platelet count (322.5 K/microL, aOR 4.01 [95% CI 1.97–8.15]), leukocytosis (10.55 K/microL, aOR 3.83 [95% CI 1.71–8.56]) and higher heart rate (over 87.5 beats per minute, aOR 2.58 [95% CI 1.22–5.46]) were independently associated with an intra-abdominal abscess. Overall, random forest and logistic regression showed similar performance. The random forest model showed an AUC of 0.824±0.065 with eight features (CRP, Hemoglobin, WBC, age, current biologic medical treatment, BUN, current immunomodulatory medical treatment, gender). Conclusion In our large tertiary center cohort, the machine-learning model identified features associated with the presentation of an intra-abdominal abscess. Such a decision support tool may assist in triaging CD patients for imaging to exclude this potentially life-threatening complication.

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn's disease visiting the emergency department.

Background:Intra-abdominal abscess (IA) is an important clinical complication of Crohn’s disease (CD). A high index of clinical suspicion is needed as imaging is not routinely used during hospital admission. This study aimed to identify clinical predictors of an IA among hospitalized patients with CD using machine learning.Methods:We created an electronic data repository of all patients with CD who visited the emergency department of our tertiary medical center between 2012 and 2018. We searched for the presence of an IA on abdominal imaging within 7 days from visit. Machine learning models were trained to predict the presence of an IA. A logistic regression model was compared with a random forest model.Results:Overall, 309 patients with CD were hospitalized and underwent abdominal imaging within 7 days. Forty patients (12.9%) were diagnosed with an IA. On multivariate analysis, high C-reactive protein (CRP) [above 65 mg/l, adjusted odds ratio (aOR): 16 (95% CI: 5.51–46.18)], leukocytosis [above 10.5 K/μl, aOR: 4.47 (95% CI: 1.91–10.45)], thrombocytosis [above 322.5 K/μl, aOR: 4.1 (95% CI: 2–8.73)], and tachycardia [over 97 beats per minute, aOR: 2.7 (95% CI: 1.37–5.3)] were independently associated with an IA. Random forest model showed an area under the curve of 0.817 ± 0.065 with six features (CRP, hemoglobin, WBC, age, current biologic therapy, and BUN).Conclusion:In our large tertiary center cohort, the machine learning model identified the association of six clinical features (CRP, hemoglobin, WBC, age, BUN, and biologic therapy) with the presentation of an IA. These may assist as a decision support tool in triaging CD patients for imaging to exclude this potentially life-threatening complication.

Clinical spectrum of intra-abdominal abscesses in patients admitted to the emergency department

BackgroundThe mortality of undrained abdominal abscesses may be as high as 35 %. In this study, we analyzed the clinical spectrum of intra-abdominal abscess (IAA) patients in the ED and attempted to identify factors that can predict the severity of IAA. MethodThis study was a retrospective review of adults (≥ 18 years) with IAA admitted to a single ED. IAA were diagnosed by abdominal computed tomography. The differences in clinical variables between patients receiving and not receiving inotropic drugs were analyzed. Multiple logistic regression was performed for assessing predictor variables. Results128 patients presented with IAA. The most common complaint was abdominal pain (60.2 %) and the liver was most common location (39.8 %). Patients who required inotropic drugs had lower serum leukocyte, lymphocyte, and platelet counts and higher serum BUN and CRP levels. The independent factors associated with need for inotropic drugs were serum leukocyte, CRP, and BUN level. The optimal cutoff CRP value for predicting inotropic drug use was 12.06mg/dL, BUN value was 21mg/dL. ConclusionsElevated CRP and BUN levels could predict a higher association with requirement of inotrope. Therefore, emergency physicians should consider CRP and BUN levels and aiming for early aggressive treatment.

A Validated Score Assessing the Risk of an Intra-Abdominal Abscess in Patients with Crohn's Disease Presenting at the Emergency Department.

A majority of acutely ill Crohn's disease [CD] patients who present to Emergency Department [ED] will undergo an abdominal CT to rule out disease complications. We aimed to generate a simple non-invasive scoring model to predict the presence of an intra-abdominal abscess in CD patients in the ED. We performed a retrospective case-control study at four Israeli hospitals from January 1, 2010 to May 30, 2018. Inclusion criteria included patients with an established diagnosis of CD that had cross-sectional abdominal imaging performed. A total of 322 patients were included, and 81 [25%] were diagnosed with an intra-abdominal abscess. In univariate analysis, ileo-colonic location (odds ratio [OR] 1.88, p = 0.0148), perianal CD [OR 7.01, p = 0.0004], fever [OR 1.88, p = 0.0247], neutrophil-to-lymphocyte ratio [OR 1.12, p < 0.0001], and C-reactive protein [OR 1.10, p < 0.0001] were significantly associated with abscess formation, whereas current use of corticosteroids was negatively associated with abscess formation [OR 0.46, 95% CI, 0.2-0.88, p = 0.0192]. We developed a diagnostic score that included five parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of ≤7 was associated with a negative predictive value [NPV] of 93% for abscess formation, whereas a high cut-off score of >9 was associated with a positive predictive value of 65%. We validated this score with an independent cohort [area under the curve of 0.881 and NPV of 98.5%]. We recommend incorporating this score as an aid for stratifying acutely ill CD patients in the ED with low or high probability of the presence of an intra-abdominal abscess.

P264 Assessing the risk for an intra-abdominal abscess in patients with Crohn's disease presenting to the emergency department

P264 Assessing the risk for an intra-abdominal abscess in patients with Crohn's disease presenting to the emergency department

Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?

Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 patients were retrospectively reviewed and the predictive factors of postoperative IAA were investigated. In addition, patients were divided into complicated appendicitis (CA) and simple appendicitis (SA) and perioperative factors of two groups were compared. Results: One hundred and forty-seven patients were diagnosed with CA, while the other 69 patients were diagnosed with SA. Sixteen patients developed postoperative IAA in the CA group, while no patients in the SA group did. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p < 0.001), operation time more than 120 min (p = 0.023) and placement of a drainage tube (p < 0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427, 95% CI: 1.586–18.57). Conclusions: IAA developed predominantly in patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.

Medical Versus Interventional Treatment of Intra-Abdominal Abscess in Patients With Crohn Disease.

Background:Few studies exist to guide the treatment approach to intra-abdominal abscesses in Crohn disease, which can include antimicrobials alone or in conjunction with percutaneous drainage or surgery. The primary aim of this study is to review outcomes from different treatment approaches to intra-abdominal abscess in Crohn disease.Methods:Medical records were reviewed for patients admitted to the University of Michigan health care system with Crohn disease and intra-abdominal abscess over a 4-year period. Outcomes were compared among medical and interventional approaches. The χ2 test was used to test for statistical significance.Results:Of the 33 patients included, 13 were in the medical group and 20 were in the interventional group. Abscess recurrence/nonresolution occurred in 31% of patients in the medical group and 25% of patients in the interventional group (P = .7).Conclusions:In this study, there was no significant difference in outcome between medical and interventional therapy for intra-abdominal abscess in Crohn disease.

Lymphocyte depression as a predictor of postoperative intraabdominal abscess after appendectomy in children

BackgroundThis study evaluated the efficacy of lymphopenia to predict postappendectomy intraabdominal abscess (IAA) in pediatric complex appendicitis. MethodsThis single-center retrospective cohort study included appendectomy patients with complex appendicitis from 4/2012 to 10/2014. IAA was diagnosed based on imaging or undergoing a drainage procedure. Labs were used from the closest day prior to abscess diagnosis or day of discharge from index admission. Lymphocyte percentage was categorized based on age-specific cutoffs with lymphopenia defined as a low percentage. Comparisons were made using chi-square or Fisher exact tests for categorical variables and Mann–Whitney U-tests for continuous variables. ResultsOf 611 appendectomy patients with complicated appendicitis, 551 had WBC and differential. IAA was identified in 79 (12.9%) patients. There were no significant differences in demographics between IAA and non-IAA groups. Patients with IAA had higher rates of leukocytosis (44.3% versus 12.3%, p<0.001) and higher rates of age-based lymphopenia (84% vs. 46%, p<0.001). IAA was independently associated with leukocytosis (OR 3.65, p<0.001) and lymphopenia (OR 4.46, p<0.001). Patients with leukocytosis and lymphopenia had the highest abscess rate (36%), and those with normal labs had the lowest (3%, p<0.001). ConclusionsLymphocyte depression is a useful adjunct to predict postoperative IAA in patients with complicated appendicitis. Level of EvidenceIII

Dynamics of Albumin Synthetic Response to Intra-Abdominal Abscess in Patients with Gastrointestinal Fistula

Low serum albumin concentration is a predictor of failure of source control for intra-abdominal infection. However, data on dynamics of albumin synthesis in these patients and to what extent these changes contribute to hypoalbuminemia are relatively scarce. We investigated in a group of patients with gastrointestinal fistula the dynamic response of liver albumin synthesis to intra-abdominal abscess and how these related to hypoalbuminemia and circulating endocrine hormone profiles. Eight gastrointestinal fistula patients scheduled to undergo percutaneous abscess sump drainage were enrolled prospectively to measure albumin synthesis rates at different stages of the inflammatory response (immediately after diagnosis and 7 d following sump drainage when clinical signs of intra-abdominal sepsis had been eradicated). Eight age-, sex-, and body mass index-matched intestinal fistula patients were studied as control patients. Consecutive arterial blood samples were drawn during a primed-constant infusion (priming dose: 4 micromol·kg(-1), infusion rate: 6 micromol·kg(-1)·min(-1)) to determine the incorporation rate of L-[ring-(2)H5]-phenylalanine directly into plasma albumin using gas chromatography/mass spectrometry analysis. Patients suffering from intra-abdominal infection had reduced plasma albumin and total plasma protein concentrations, compared with control patients. Albumin fractional synthesis rates in patients with intra-abdominal abscess were decreased, compared with those in the control group. When the source of infection was removed, albumin synthesis rates returned to control values, whereas albumin concentrations did not differ significantly from the corresponding concentrations in control subjects and patients with intra-abdominal abscess. Despite nutritional intervention, albumin synthesis rate is decreased in intestinal fistula patients with intra-abdominal abscess; albumin synthesis returns to control values during convalescence.

Diagnostic value of serum procalcitonin in detecting intra-abdominal abscess in patients with Crohn's disease

Hu, Dong MD; Ren, Jianan MD, PhD, FACS; Liu, Song MD; Yan, Dongsheng MD; Wang, Gefei MD, PhD; Gu, Guosheng MD, PhD; Chen, Jun MD, PhD Author Information

Prospective observational study of the frequency and features of intra-abdominal abscesses in patients with melioidosis in northeast Thailand

SummaryRetrospective case series from Thailand have reported the presence of intra-abdominal abscesses in around half of patients with melioidosis, a much higher rate than our clinical experience would suggest. We performed a prospective, observational study of 230 adult patients with culture-confirmed melioidosis in which all patients underwent abdominal ultrasound. One or more abscesses were detected in the liver and/or spleen in 77 (33%) cases. These were often multiple (70%, 31/44 in hepatic abscesses and 88%, 50/57 in splenic abscesses) and clinically silent (27% of cases with abscesses presenting with abdominal pain). The mortality rate at 4 weeks post-discharge was lower in patients who were abscess-positive vs abscess-negative (10%, 8/77 vs 20%, 31/153).

Similar Outcomes of Surgical and Medical Treatment of Intra-abdominal Abscesses in Patients With Crohn's Disease

It is not clear whether medical therapy, surgery, or both is the best approach for patients with Crohn's disease who develop an intra-abdominal abscess. We evaluated data from patients with Crohn's disease who were diagnosed with a radiologically confirmed abdominal abscess (enhancing fluid collection, ≥ 1 cm) from 1999 to 2006 (n = 95; median age, 42.0 y; 50.5% female). Medical/nonsurgical methods (percutaneous aspiration ± drain placement) were used for 55 patients (mean abscess size, 6.9 ± 3.2 cm), and 40 patients underwent surgical interventions (laparotomy ± bowel resection; mean abscess size, 7.5 ± 3.7 cm). We investigated risk factors for abscess recurrence. The median length of hospitalization was 15.5 days for patients who underwent surgery and 5.0 days for patients who did not (P < .001). The 5-year cumulative probability of abscess recurrence was 31.2% among patients who did not undergo surgery and 20.3% among those who did (P = .25). Histories of perianal or active ileal disease predicted abscess recurrence. Initiation of pharmacologic therapy after drainage reduced the risk for abscess recurrence (P < .001). Anti-tumor necrosis factor therapy, compared with no therapy, reduced the risk of abscess recurrence (P = .001) in all patients, whereas immunosuppressive monotherapy, compared with no therapy, had a trend toward significant risk reduction (P = .06). Among patients with Crohn's disease who have intra-abdominal abscesses, nonsurgical and primary surgical management strategies result in similar rates of abscess recurrence and complications. Initiation of anti-tumor necrosis factor and/or immunosuppressive therapy when abscesses resolve might protect against intra-abdominal penetrating disease.

Clinical characteristics and surgical treatment of Crohn disease complicated with intra-abdominal abscess

To elucidate the clinical characteristics and surgical treatment of intra-abdominal abscess in patients with Crohn disease(CD). Clinical data of 39 patients with CD complicated with intra-abdominal abscess from 2000 to 2005 were analyzed retrospectively. The cumulative incidence of intra-abdominal abscesses was 27.5%. Of the 39 CD patients with abscess, 61.5% had surgery the time of present study. The mean age of the patients with abscesses was (34.7+/- 12.3) years, and the duration of illness from the onset of CD until development of an abscess was (0-22) years,with 5 years of the average duration. In terms of location of abscess, it occurred most often on the right side (76.9%), especially near the site of anastomosis (48.7%). Most patients (34 cases, 94.4%) were treated with surgical drainage and intestinal resection. Abscess formation was noted in 27.5% of patients with CD, with nearly half of abscesses occurring near the anastomotic site. The mean age of patients with abscess was 35 years, with 5 years of the duration of illness. Most abscesses were treated with operative drainage and intestinal resection.

Review: antibiotics reduce wound infections and intra-abdominal abscesses in patients having appendectomy

Review: antibiotics reduce wound infections and intra-abdominal abscesses in patients having appendectomy

Risk of abdominal septic complications after feeding jejunostomy placement in patients undergoing splenectomy for trauma

Compared with total parenteral nutrition, enteral feeding via jejunostomy reduces septic complications in patients with severe trauma. However, violation of the bowel with insertion of a jejunostomy tube may increase the risk of intra-abdominal abscess (IAA), particularly if no simultaneous gastrointestinal tract injury exists. The records of 123 patients requiring splenectomy for trauma at a level I trauma center during a 6-year period (1986 to 1992) were reviewed to examine the incidence of IAA in patients with and without simultaneous jejunostomy placement in the presence and absence of gastrointestinal tract injuries. Thirty patients had jejunostomies placed (J), and 93 did not (NoJ). There were no significant differences between the groups in age, Abdominal Trauma Index, Injury Severity Score, or transfusion requirements. The incidence of IAA was not significantly different between the J and NoJ groups in the presence or absence of gastrointestinal tract injuries. Thus, jejunostomy placement does not increase the incidence of IAA after splenectomy regardless of the presence of a gastrointestinal tract injury.

The Diagnosis of Intra-abdominal Abscesses in Patients with Severe Crohn's Disease

A series of 24 patients with severe relapses of Crohn's disease responding poorly to conventional treatment with corticosteroids was studied to determine the incidence of intra-abdominal abscesses and the best means to detect them. Ultrasound scans proved to be difficult to interpret and unreliable. Computed tomography demonstrated abnormal bowel thickening in most cases, and showed seven of the eight intraabdominal abscesses. 111In leucocyte scintigraphy always demonstrated inflamed areas of bowel, but underestimated the extent of disease in three patients and overestimated it in five. All eight abdominal abscesses were detected, and there were no false-positive results. It was always possible to distinguish the abscess from inflamed bowel wall. Intra-abdominal abscess is not uncommon in patients with severe relapses of Crohn's disease which are not responsive to corticosteroid therapy, being present in about one-third of patients. 111In leucocyte scintigraphy is a simple and helpful test for differentiating between active inflammatory bowel disease and complicating abscesses, contributing significantly to the management of patients with severe Crohn's disease.