Abscesses in Crohn's disease: outcome of medical versus surgical treatment.
OBJECTIVE
To compare the long-term outcome of medical, percutaneous, and surgical treatment of abdominal and pelvic abscesses complicating Crohn's disease.


METHODS
All patients with Crohn's disease and an abdominal abscess treated at one institution during a 10-year period were retrospectively identified. We reviewed hospital and outpatient records and contacted patients for telephone interviews. Outcome measures included abscess recurrence, subsequent surgery for Crohn's disease, and medications used at the time of most recent follow-up.


RESULTS
Fifty-one subjects were identified, with a mean follow-up of 3.75 years. Fewer patients developed recurrent abscesses after initial surgical drainage and bowel resection (12%) than patients treated with medical therapy only or percutaneous drainage (56%) (p = 0.016). One half of the patients treated nonoperatively ultimately required surgery, whereas only 12% of those treated with initial surgery required reoperation during the follow-up period (p = 0.010). Most failures of nonoperative therapy occurred within 3 months. Medication use was similar between the treatment groups at the time of most recent follow-up.


CONCLUSIONS
In this series, surgical management of abscesses in Crohn's disease was more effective than medical treatment or percutaneous drainage for prevention of abscess recurrence. However, nonoperative therapy prevented subsequent surgery in half of the patients and may be a reasonable treatment option for some patients.
Garcia
J C
JC
Division of Digestive Diseases and the Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Persky
S E
SE
Bonis
P A
PA
Topazian
M
M
D018784:Abdominal Abscess / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome