Outcome of Surgical Versus Percutaneous Drainage of Abdominal and Pelvic Abscesses in Crohn's Disease

Gutierrez, Alexandra; Lee, Hang; Sands, Bruce E.

doi:10.1111/j.1572-0241.2006.00757.x

Cited by 113 publications

(82 citation statements)

References 6 publications

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“…If necessary, drainage can be followed by one-stage surgery (resection and anastomosis performed in the same procedure). This approach is especially useful when the abscess develops against a background of active disease [26,43].…”

Section: Clinical Aspectsmentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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Section: Clinical Aspectsmentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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“…In another study, 6 of 7 patients that did not have elective surgery had a severe recurrence within 3 years [1] . On the other hand, some studies have shown the majority of patients do well after PAD without definitive surgery and that the recurrence rate is acceptably low [10] . Golfieri et al [8] found that only 12.6% of 70 patients developed a recurrent abscess after a mean follow-up of 39 mo and that only 5/11 of these patients required urgent surgery.…”

Section: Timing Of Surgerymentioning

confidence: 99%

“…A palpable mass is present EDITORIAL in about 1/3 of patients. Rebound tenderness occurs 30% of the time [10] . Clinicians should be aware that elderly or immune suppressed patients sometimes manifest fewer signs and symptoms [9] .…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…Most often it is defined as a ring enhancing fluid collection, with or without air [15] . Some authors include the aspiration of pus as a diagnostic inclusion criterion [10] . The next step in management depends on the patient's clinical status.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…Generally, success is defined as resolution of symptoms with collapse of the abscess cavity and avoidance of early surgery (within 30-60 d) [3,5,10,20,28,29] . With this definition in mind, success rates vary from 50%-95% [3,5,8,19,23] .…”

Section: Success Of Percutaneous Abscess Drainagementioning

confidence: 99%

See 2 more Smart Citations

Management of abdominal and pelvic abscess in Crohn’s disease

Richards

2011

WJGE

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Patients with Crohn's disease may develop an abdominal or pelvic abscess during the course of their illness. This process results from transmural inflammation and penetration of the bowel wall, which in turn leads to a contained perforation and subsequent abscess formation. Management of patients with Crohn's related intra-abdominal and pelvic abscesses is challenging and requires the expertise of multiple specialties working in concert. Treatment usually consists of percutaneous abscess drainage (PAD) under guidance of computed tomography in addition to antibiotics. PAD allows for drainage of infection and avoidance of a two-stage surgical procedure in most cases. It is unclear if PAD can be considered a definitive treatment without the need for future surgery. The use of immune suppressive agents such as anti-tumor necrosis factor-α in this setting may be hazardous and their appropriate use is controversial. This article discusses the management of spontaneous abdominal and pelvic abscesses in Crohn's disease.

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Crohn's Disease: Clinical Course and Complications

Sands

2010

Inflammatory Bowel Disease

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Outcome of Surgical Versus Percutaneous Drainage of Abdominal and Pelvic Abscesses in Crohn's Disease

Cited by 113 publications

References 6 publications

Surgery and diagnostic imaging in abdominal Crohn’s disease

Surgery and diagnostic imaging in abdominal Crohn’s disease

Management of abdominal and pelvic abscess in Crohn’s disease

Crohn's Disease: Clinical Course and Complications

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