This study compares the outcome of different treatment options for spontaneous intra-abdominal abscesses in active Crohn’s disease.
A retrospective analysis of Crohn’s disease patients between January 2007 and December 2018 was performed in two Belgian IBD centres. Successful conservative management was defined as complete abscess resolution without the need for bowel resection. The primary outcome was suboptimal evolution, defined as a composite outcome of abscess recurrence, postoperative complications and/or need for a non-elective resection.
We evaluated 43 Crohn’s patients that presented with an intra-abdominal abscess. One patient underwent immediate bowel resection because of septic shock. In all other 42 cases a conservative approach was taken (including drainage), which led to a complete abscess resolution rate of 28.6% (12/42). The remaining patients (30/42) required bowel resection. Anti-TNF use was associated with successful conservative management (OR = 13.36; 95% CI: 11.19-15.52; P = 0.006), while an opposite trend was found for corticosteroids (OR = 0.14; 95% CI: -2.03-2.32; P = 0.055). There was a trend towards suboptimal evolution in case of previous bowel resection (OR = 4.77; 95% CI: 0.77-29.66; P = 0.094) or age above 50 years (OR = 5.17; 95% CI: 0.86-30.91; P = 0.072).
Bowel resection appears to be inevitable in the majority of Crohn’s patients presenting with an intra-abdominal abscess. Based on our series, an attempt for conservative treatment may particularly be successful with anti-TNF in younger patients that have not undergone previous bowel resection. Large-scale prospective studies are needed to confirm these findings.