Management of Intra-abdominal Abscesses in Children With Crohnʼs Disease

Abstract

Background Intra-abdominal abscesses (IAA) are complications of Crohn’s disease, which often result in hospitalization, surgery, and increased cost. Initial management may include medical therapy, percutaneous drainage (PD), or surgery, although the optimal management of IAA in children is unclear. Methods Retrospective review of all pediatric patients with Crohn’s disease who developed an IAA from January 1, 2000 to April 30, 2012. Three groups, based on initial IAA treatment modality (medical, PD, and surgery), were compared. Results Thirty cases of IAA were identified (mean age at IAA diagnosis, 15.4 ± 2.6 yr, 67% female, median Crohn’s disease duration, 2.6 mo). Computed tomography was the most common initial (93%) and follow-up (47%) imaging. The average time to follow-up imaging was 8.5 days. For initial management, 18 received medical therapy, 10 PD, and 2 had surgery. The medical therapy group received more computed tomography scans for follow-up imaging than the PD group (12 [67%] versus 2 [20%], P = 0.046). There were no significant differences in abscess characteristics or management of posttreatment course between these 2 groups. Surgical resection occurred in 3 patients (17%) in the medical group and 2 (20%) in the PD group during index hospitalization. No significant differences were identified among treatment groups for readmissions, complications, or abscess recurrence. By 1 year, 12 of the 18 medically managed patients (67%) had surgery, and 6 of the 10 patients (60%) treated with initial PD ultimately had surgery. Conclusions The majority of patients with IAA require definitive surgical treatment, and there were no clear predictors of those who did not.

Management of intra‐abdominal abscess in Crohn's disease

“…published a single centre series on young patients with intra‐abdominal abscesses with Crohn's disease. In this study, 60% of patients with intra‐abdominal abscess required surgery, and at 1 year, 67% of patients who were managed with initial non‐operative managed required surgical intervention …”

“…In this study, 60% of patients with intra-abdominal abscess required surgery, and at 1 year, 67% of patients who were managed with initial nonoperative managed required surgical intervention. 2 The literature suggests that some Crohn's disease patients with intra-abdominal abscesses may be managed non-operatively. Lee et al reported a 66.7% success rate in non-operative management of Crohn's disease patients with intra-abdominal abscess, but only without concurrent steroids and relevant fistulae.…”

Predictors for Invasive Therapy in the Management of Crohn’s Disease-related Spontaneous Intra-abdominal Abscess: Prognosis and Long-term Follow-up

“…In addition, at the 1-year follow-up, 67% of patients who were managed with initial nonoperative management required surgical intervention [20]. When choosing conservative medical treatment, we recommend using strict indications and close clinical observation.…”

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients

“…On the other hand, they would prefer US imagining over other imaging modalities for follow-up imaging (47%) [ 65 ]. Another study by Dotson et al found out that, at a single institution, CT was the imaging modality most frequently used for the follow-up imaging of Chron’s-related pediatric abdominal abscesses [ 66 ]. Such a practice differs quite significantly from that of our institution, favoring US for both initial and follow-up imaging, at least in uncomplicated cases.…”