BACKGROUND: Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn's disease (CD) with radiologically guided percutaneous drainage (PD) was debated. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello Palermo Italy

Chelsea and Westminster Hospital NHS Foundation Trust London UK

Colorectal Surgery Unit Hospital Universitario Madrid Del Henares Spain

Colorectal Surgery Unit Hospital Universitario Son Espases Mallorca Spain

Colorectal Surgery Vall d'Hebron University Hospital Barcelona Spain

Department of Advanced Medical and Surgical Sciences Università degli Studi della Campania Luigi Vanvitelli Naples Italy

Department of Biomedical Sciences IRCCS Humanitas Research Hospital Humanitas University Milan Italy

Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute Brno Czech Republic

Department of Gastroenterology Herlev Hospital Herlev Denmark

Department of Internal Medicine Gastroenterology and Geriatrics University Hospital Olomouc Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Surgery Aalborg University Aalborg Denmark

Department of Surgery Aalborg University Hospital Aalborg Denmark

Department of Surgery Cedars Sinai Medical Center Los Angeles California USA

Department of Surgery Faculty of Medicine University Hospital Brno Masaryk University Brno Czech Republic

Department of Surgery Hospital del Mar Spain

Department of Surgery Hvidovre Hospital Hvidovre Denmark

Department of Surgery St Mark's and Northwick Park Hospital London UK

Department of Surgery Städtisches Klinikum München Bogenhausen Munich Germany

Department of Surgery University Hospital La Fe University of Valencia Spain

Division of General and HPB Surgery Luigi Sacco Hospital Milano Italy

Faculty of Medicine Gazi University Ankara Turkey

Medicine Faculty Universidad Francisco de Vitoria Madrid Spain

OpenSourceResearch Collaboration Aalborg Denmark

Research Unit for Surgery and IBD Care Odense University Hospital University of Southern Denmark Odense Denmark

School of Medicine Kocaeli University Kocaeli Turkey

Sheba Medical Center Sackler Medical School Tel Aviv University Ramat Gan Israel

Surgery Università degli Studi di Milano Milan Italy

Crohns Colitis 360. 2023 Sep 18;5(3):otad049. doi: 10.1093/crocol/otad049. PubMed

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Adamina  M, Bonovas  S, Raine  T, et al.  ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. J Crohns Colitis. 2020;14(2):155-168. doi:10.1093/ecco-jcc/jjz187 PubMed DOI

El-Hussuna  A, Karer  MLM, Uldall Nielsen  NN, et al.  Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn’s disease. BJS Open. 2021;5(5):zrab075. doi:10.1093/bjsopen/zrab075 PubMed DOI PMC