Percutaneous abdomino-pelvic abscess drainage in complicated Crohn’s disease

Purpose: Percutaneous abscess drainage (PAD) is the first-line approach for abscess in Crohn’s disease (CD) since it procrastinates or avoids surgery especially in postoperative abscesses [within 30 days post-operative (p.o.)]. We retrospectively evaluated the effectiveness, complications and outcome after PAD in postoperative and spontaneous abscesses and factors influencing the outcomes. Methods: We performed PAD in 91 abscesses, 45 (49,5%) postoperative and 46 (50,5%) spontaneous. We defined the overall success (OS) as clinical (CS) and technical success (TS) when imaging documented the resolution of the abscess with no surgery within 30 days. Conversely, patients without abscess at the time of surgery, were considered as TS but clinical failure (CF). We also analyzed the overall failure (OF) defined as CF with or without technical failure (TF). Overall technical success (OTS) was OS plus TS. Complications were classified as major and minor according to the Interventional Radiology Criteria. Results: In postoperative abscesses we found 91% OS, 9% OF, no TF and 100% OTS. In spontaneous abscesses we found 33% OS, 67% OF, 6.4% TF, 95,6% OTS. A total abscess resolution was achieved in 97,8% of patients. No major complication occurred; only 1 case of minor complication. Factors statistically influencing the outcome were postoperative vs spontaneous collections (OF: 9% vs. 67%, p < 0.0001), multiloculated vs uniloculated collections (OF: 38% vs. 1%, p < 0.0001) and upper abdominal vs lower location (OF: 13% vs. 25%, p <0.05). Conclusion: Our data confirms the safety and effectiveness of PAD even in cases needing surgery within 30 days; most remarkable, PAD allows avoidance of early reoperation in almost all the patients with postoperative abscess.

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Successful pelvic abscess drainage by cecal biopsies in Crohn's disease

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.06.021 ◽

2011 ◽

Vol 73 (1) ◽

pp. 158-159

Author(s):

Javier Molina-Infante ◽

Belen Perez-Gallardo ◽

Patricia Barros-Garcia

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pelvic Abscess ◽

Abscess Drainage

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Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease

International Journal of Colorectal Disease ◽

10.1007/s00384-011-1135-6 ◽

2011 ◽

Vol 26 (6) ◽

pp. 769-774 ◽

Cited By ~ 27

Author(s):

René Müller-Wille ◽

Igors Iesalnieks ◽

Christian Dornia ◽

Claudia Ott ◽

Ernst Michael Jung ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abscess Drainage ◽

Septic Complications ◽

Percutaneous Abscess Drainage ◽

Postoperative Septic Complications

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Percutaneous abscess drainage in Crohn's disease

American Journal of Roentgenology ◽

10.2214/ajr.148.5.859 ◽

1987 ◽

Vol 148 (5) ◽

pp. 859-862 ◽

Cited By ~ 58

Author(s):

HD Safrit ◽

MA Mauro ◽

PF Jaques

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abscess Drainage ◽

Percutaneous Abscess Drainage

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CT-guided percutaneous pelvic abscess drainage in Crohn’s disease

Techniques in Coloproctology ◽

10.1007/s10151-006-0260-7 ◽

2006 ◽

Vol 10 (2) ◽

pp. 99-105 ◽

Cited By ~ 36

Author(s):

R. Golfieri ◽

A. Cappelli ◽

E. Giampalma ◽

F. Rizzello ◽

P. Gionchetti ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pelvic Abscess ◽

Abscess Drainage ◽

Ct Guided

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Effect of Systemic Corticosteroid Therapy on Risk for Intra-Abdominal or Pelvic Abscess in Non-operated Crohn’s Disease

Clinical Gastroenterology and Hepatology ◽

10.1016/s1542-3565(05)00759-7 ◽

2005 ◽

Vol 3 (12) ◽

pp. 1215-1220 ◽

Cited By ~ 44

Author(s):

Anurag Agrawal ◽

Shireen Durrani ◽

Keith Leiper ◽

Anthony Ellis ◽

Anthony I. Morris ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Corticosteroid Therapy ◽

Systemic Corticosteroid ◽

Pelvic Abscess ◽

Systemic Corticosteroid Therapy

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Incidence and Microbiology of Abdominal and Pelvic Abscess in Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(82)80139-x ◽

1982 ◽

Vol 83 (6) ◽

pp. 1271-1275 ◽

Cited By ~ 72

Author(s):

M.R.B. Keighley ◽

D. Eastwood ◽

N.S. Ambrose ◽

R.N. Allan ◽

D.W. Burdon

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pelvic Abscess

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Intra-abdominal and pelvic abscess in Crohn's disease: results of non-invasive and surgical management

British Journal of Surgery ◽

10.1046/j.1365-2168.1998.00575.x ◽

1998 ◽

Vol 85 (3) ◽

pp. 367-371 ◽

Cited By ~ 70

Author(s):

Jawhari ◽

Kamm ◽

Ong ◽

Forbes ◽

Bartram ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Management ◽

Pelvic Abscess ◽

Non Invasive

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Outcomes of Definitive Draining Seton Placement for Complex Anal Fistula in Crohn’s Disease

The American Surgeon ◽

10.1177/0003134820964462 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1368-1372

Author(s):

Angela Mujukian ◽

Karen Zaghiyan ◽

Elliot Banayan ◽

Phillip Fleshner

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Biologic Therapy ◽

Median Number ◽

Fistula Formation ◽

Anal Stenosis ◽

Study Cohort ◽

Almost All

Definitive draining seton (DDS) alone is an accepted treatment for complex refractory anal fistulas in Crohn’s disease (CD). We evaluated the long-term success of DDS in CD patients. DDS was defined as draining seton placed definitively for at least 12 months. Primary end point was clinical response (CR) defined as a lack of induration, pain, swelling, abscess recurrence, or unintended dislodgement. The study cohort of 23 patients had a median age of 29 (range; 9-61) years and included 14 males (61%). Reasons for DDS included anal stenosis (n = 9; 39%), active proctitis (n = 9; 39%), and/or anal canal ulceration (n = 9; 39%). Median number of setons was 2 (range; 1-6) and 65% had multiple fistula tracts. Almost all patients (n = 22; 96%) were on a biologic postoperatively. At 12-month follow-up, only 39% (n = 9) had a CR. The remaining 14 patients failed due to new abscess formation (n = 6; 26%), new fistula formation (n = 6; 26%), and seton dislodgement (n = 2; 9%). Six (26%) patients required fecal diversion. No patients required proctectomy. DDS for complex CD fistula results in a mediocre CR with many patients developing recurrent abscess/fistula or requiring diversion despite biologic therapy.

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Large paraspinal abscess as a complication of infliximab therapy in Crohn’s disease

BMJ Case Reports ◽

10.1136/bcr-2018-227665 ◽

2019 ◽

Vol 12 (4) ◽

pp. e227665 ◽

Cited By ~ 1

Author(s):

Nishani Nithianandan ◽

Michael J Loftus ◽

Paul D R Johnson ◽

Patrick G P Charles

Keyword(s):

Staphylococcus Aureus ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Infliximab Therapy ◽

Abscess Drainage ◽

Paraspinal Abscess

We report a 36-year-old man who developed a large epidural and paraspinal abscess as a complication of infliximab therapy being used for underlying Crohn’s disease. Cultures of the collection grew methicillin-susceptible Staphylococcus aureus, and treatment consisted of abscess drainage, prolonged intravenous and oral flucloxacillin and temporary withholding of his infliximab. While infection-related complications are well described with infliximab therapy, this is the first description of a large paraspinal abscess with epidural extension.

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Endoscopic treatment of Crohn-related strictures with a self-expandable stent compared with balloon dilation: a prospective, randomised, controlled study

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000612 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000612

Author(s):

Per Hedenström ◽

Per-Ove Stotzer

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Adverse Events ◽

Endoscopic Treatment ◽

Clinical Success ◽

Balloon Dilation ◽

Controlled Study ◽

Metal Stents ◽

Technical Success ◽

Increased Risk

ObjectiveFibrotic strictures in the gastrointestinal tract are frequent in Crohn’s disease. Endoscopic dilation is a standard treatment. However, recurrence is common after dilation and there are complications such as bleeding or perforation. Endoscopic treatment using self-expandable metal stents has shown diverging results. The aim of this study was to evaluate the outcome of endoscopic treatment with a self-expandable stent in ileocecal Crohn’s disease.Design/methodPatients with Crohn’s disease and a symptomatic ileocecal stricture were eligible for prospective, consecutive inclusion in a single-centre setting. Patients were randomised to treatment with either 18 mm balloon dilatation (GroupDIL) or stenting (GroupSTENT) using a 20 mm diameter, partially covered Hanarostent NCN. Patients were followed for a minimum of 24 months postendoscopy. Outcomes were technical success, adverse events and clinical success (defined as no need for repeated interventions).ResultsThirteen patients (GroupDIL n=6; GroupSTENT=7) were included with twelve patients (GroupDIL n=5; GroupSTENT=7) being eligible for complete follow-up. Technical success was achieved in all cases. Adverse events were border-line significantly more common in the GroupSTENT: 4/7 (57%) (pain: n=3; pain and rectal bleeding: n=1) compared with the GroupDIL: 0/5 (0%), p=0.08, which resulted in preterm termination of the study. The clinical success rate was GroupSTENT: 6/7 (86%) vs GroupDIL: 1/5 (20%), p=0.07.ConclusionPatients with strictures related to Crohn’s disease may benefit from treatment with self-expandable metal stents rather than dilatation. However, there seems to be an increased risk for patient pain after stenting, which has to be considered and handled.Trail registration numberThe study was registered at Clinical Trials (NCT04718493).

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