Intra-abdominal Abscess In Crohn's Disease Research Articles

Imaging Features Associated With Failure of Nonoperative Management of Intraabdominal Abscesses in Crohn Disease.

Intraabdominal abscess management decisions in the treatment of Crohn disease (CD) can be challenging. Our aim was to determine the effect of clinical, medication use, and imaging disease characteristics on the need for future surgical management. A retrospective chart review was performed in patients with CD hospitalized for abscess confirmed by imaging between 2008 and 2016. Selection criteria included nonoperative management with intravenous antibiotics at the index hospitalization and a minimum of 2 years of follow up. Demographic, disease, and medication history were extracted from electronic medical records. Radiographic disease features were assessed by an expert abdominal radiologist, blinded to clinical data. The primary outcome was resection of the bowel segment involving the abscess within 2 years of index hospitalization. Cox proportional hazards regression and statistical methods were performed using SAS 9.4. Of the 121 patients meeting the selection criteria, 36.4% avoided surgery after 2 years of follow up. On adjusted multivariable analysis, disease-activity factors including bowel wall thickness (HR 3.08, 95% CL 1.20-6.21), disease length (HR 2.67, 95% CL 1.40-6.20), bowel dilation (HR 2.19, 95% CL 1.02-4.68), and abscess size of greater than 6 cm (HR 2.47, 95%CL 1.17-5.21) were independent risk factors for future surgery in patients not undergoing immediate bowel resection for abscess management. Biologic use and percutaneous drainage were not risk factors for ultimate surgical management. Radiographic CD features and abscess size over 6 cm are predictors of ultimately requiring bowel resection. Radiographic measures may help stratify patients to immediate surgery or conservative management for intraabdominal CD-related abscesses.

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.

Bacteriology of Spontaneous Intra-Abdominal Abscess in Patients with Crohn Disease in China: Risk of Extended-Spectrum Beta-Lactamase-Producing Bacteria

Crohn disease (CD) has its own features and the etiology is believed to be related to the gastrointestinal flora, which are the cause of most intra-abdominal infections. However, few experiences have been reported regarding the specific bacteriology of spontaneous intra-abdominal abscess (IAA) in CD patients and related risk factors. In the present study, we aim to investigate the bacteriology of IAA in CD and the associated risk factors. Retrospective study on 97 CD patients suffering from IAA was performed from January 2007 to December 2012. Microbiologic information of pus cultures was pooled, and logistic regression was applied to examine the possible factors affecting the incidence of common organisms and the bacteria producing extended-spectrum beta-lactamase (ESBL). Of the 97 patients recruited, 151 aerobic bacteria were cultured from the pus of IAA. The leading bacteria were Escherichia coli (57.7%), Klebsiella pneumoniae (19.6%) and Enterococcus faecium (18.6%). Extended-spectrum beta-lactamase-producing bacteria were more commonly found among CD patients receiving immunosuppressant. Broad-spectrum antibiotics are recommended for treating IAA in CD. Empirical antibiotic coverage against ESBL-producing bacteria in patients receiving immunosuppressive therapy is advocated. Considering the predominance of Enterococcus faecium, it may be advisable to use more effective antibiotics when gram-positive cocci are suspected.

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.

NASPGHAN Clinical Report on the Evaluation and Treatment of Pediatric Patients With Internal Penetrating Crohn Disease

Natural History of Pediatric Crohn Disease T he natural history of pediatric Crohn disease (CD) remains unpredictable, although some trends are observed that differentiate children from adults. Pediatric CD often presents with more severe disease and more frequent need for immunosuppressive therapy (1). Growth failure, present in 15% to 20% of patients, is a unique characteristic of pediatric CD not seen in adult-onset CD (2). Colonic disease distribution is common in patients younger than 10 years (1). The need for surgical intervention also varies, with 1 study reporting the actuarial risk of having undergone an extensive intestinal resection being 48.6% 5% in a childhood-onset group versus 14.6% 2% in the adult-onset group (P< 0.001) (1). More recently, long-term follow-up of patients enrolled in pediatric registries shows a cumulative surgical rate of 14% to 17% at 5 years and 28% at 10 years (3,4).