Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn’s Disease Might Be Associated With Increased Rates of Stoma Construction

Abstract

Background Management of spontaneous intra-abdominal abscess in patients with Crohn’s disease (IAA) with radiologically guided percutaneous drainage (PD) was debated. Method This is a secondary analysis from a multi-centre, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centres. 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 higher risk of stoma construction at later stages 8/17 (47.1%) vs. 90/326 (27.6%) (p<0.01). 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=0.07). Conclusion 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, LOS, re-admission, 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