title: Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn's disease.
abstract: OBJECTIVE
  Abdominal and pelvic abscesses are a common complication of Crohn's disease. We studied the effect of the initial choice of therapy on time to resolution of abdominal and pelvic abscesses.
  
  
  METHODS
  We recorded clinical, laboratory, and radiographic data on all adult patients with Crohn's disease and abdominal or pelvic abscesses treated at our institution from 1991 to 2001 and followed > or = 1 yr. Univariate analysis identified variables associated with initial choice of drainage modality. These variables were included in a Cox regression model to identify factors independently associated with time to resolution.
  
  
  RESULTS
  Of 66 episodes identified, surgery was the initial modality in 29 and percutaneous drainage in 37. Median time to resolution was not different between surgical drainage (25.0 days, range 0-240) and percutaneous drainage (21.5 days, range 0-182) (p = 0.084). Older age, longer duration of symptoms prior to drainage, no fistula identified radiographically, immune modulator use, no rebound tenderness, and admission to the medical service were factors associated with percutaneous drainage as initial modality. These factors, when incorporated in a Cox regression model, did not significantly affect the time to resolution. Days from onset of symptoms to radiographic diagnosis or drainage were independently associated with time to resolution of the abscess.
  
  
  CONCLUSIONS
  Time to resolution of abdominal or pelvic abscesses in Crohn's disease is similar with percutaneous drainage and surgery. One-third of patients treated with percutaneous drainage required surgery within 1 yr. Earlier intervention for abdominal and pelvic abscesses is associated with shorter time to resolution.
authors.affiliation: Gastrointestinal Unit and MGH Crohn's and Colitis Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gutierrez
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D034161:Pelvic Infection / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome