title: Abdominal phlegmons in Crohn's disease: outcomes following antitumor necrosis factor therapy.
abstract: BACKGROUND
  An abdominal phlegmon is an inflammatory mass that can develop in the setting of penetrating Crohn's disease (CD). Anti-tumor necrosis factor (TNF) antibody therapy is typically avoided in CD complicated by phlegmon because of concern for peritoneal infection but may offer an effective alternative to surgical resection after infection has been controlled with antibiotics. The aim of this study was to examine outcomes for patients with CD who developed an abdominal phlegmon that was subsequently treated with an anti-TNF antibody.
  
  
  METHODS
  We retrospectively reviewed the records of all CD patients attending Beth Israel Deaconess Medical Center between 2004 and 2010 with an abdominal phlegmon who were treated with an anti-TNF antibody in order to evaluate the safety and efficacy of this treatment regimen.
  
  
  RESULTS
  There were 13 patients with CD complicated by a phlegmon treated with antibiotics and an anti-TNF antibody at our center between 2004 and 2010. Ten were male. Median time (interquartile range) from diagnosis to development of the phlegmon was 5.9 (1.9-22.7) years. The phlegmon was associated with an abscess in 12 patients. In addition to anti-TNF therapy, all patients were treated with broad-spectrum antibiotics. Anti-TNF therapy was effective without complications in all subjects. Two patients eventually had surgery more than a year after initiating anti-TNF treatment.
  
  
  CONCLUSIONS
  Penetrating CD complicated by phlegmon formation may be safely and effectively managed with a combination of antibiotics and anti-TNF therapy. Larger, prospective trials are required to confirm these initial findings.
authors.affiliation: Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts 02215, USA. gcullen@bidmc.harvard.edu
authors.forename: Garret
authors.initials: G
authors.lastname: Cullen
authors.forename: Byron
authors.initials: B
authors.lastname: Vaughn
authors.forename: Awais
authors.initials: A
authors.lastname: Ahmed
authors.forename: Mark A
authors.initials: MA
authors.lastname: Peppercorn
authors.forename: Martin P
authors.initials: MP
authors.lastname: Smith
authors.forename: Alan C
authors.initials: AC
authors.lastname: Moss
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
mesh_terms: D000005:Abdomen; D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy*; D000068582:Certolizumab Pegol; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D007140:Immunoglobulin Fab Fragments; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol