title: Similar outcomes of surgical and medical treatment of intra-abdominal abscesses in patients with Crohn's disease.
abstract: OBJECTIVE
  It is not clear whether medical therapy, surgery, or both is the best approach for patients with Crohn's disease who develop an intra-abdominal abscess.
  
  
  METHODS
  We evaluated data from patients with Crohn's disease who were diagnosed with a radiologically confirmed abdominal abscess (enhancing fluid collection, ≥ 1 cm) from 1999 to 2006 (n = 95; median age, 42.0 y; 50.5% female). Medical/nonsurgical methods (percutaneous aspiration ± drain placement) were used for 55 patients (mean abscess size, 6.9 ± 3.2 cm), and 40 patients underwent surgical interventions (laparotomy ± bowel resection; mean abscess size, 7.5 ± 3.7 cm). We investigated risk factors for abscess recurrence.
  
  
  RESULTS
  The median length of hospitalization was 15.5 days for patients who underwent surgery and 5.0 days for patients who did not (P < .001). The 5-year cumulative probability of abscess recurrence was 31.2% among patients who did not undergo surgery and 20.3% among those who did (P = .25). Histories of perianal or active ileal disease predicted abscess recurrence. Initiation of pharmacologic therapy after drainage reduced the risk for abscess recurrence (P < .001). Anti-tumor necrosis factor therapy, compared with no therapy, reduced the risk of abscess recurrence (P = .001) in all patients, whereas immunosuppressive monotherapy, compared with no therapy, had a trend toward significant risk reduction (P = .06).
  
  
  CONCLUSIONS
  Among patients with Crohn's disease who have intra-abdominal abscesses, nonsurgical and primary surgical management strategies result in similar rates of abscess recurrence and complications. Initiation of anti-tumor necrosis factor and/or immunosuppressive therapy when abscesses resolve might protect against intra-abdominal penetrating disease.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.forename: Brenda
authors.initials: B
authors.lastname: Becker
authors.forename: Jay
authors.initials: J
authors.lastname: Mandrekar
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents