title: Management of intra-abdominal abscesses in children with Crohn's disease: a 12-year, retrospective single-center review.
abstract: BACKGROUND
  Intra-abdominal abscesses (IAA) are complications of Crohn's disease, which often result in hospitalization, surgery, and increased cost. Initial management may include medical therapy, percutaneous drainage (PD), or surgery, although the optimal management of IAA in children is unclear.
  
  
  METHODS
  Retrospective review of all pediatric patients with Crohn's disease who developed an IAA from January 1, 2000 to April 30, 2012. Three groups, based on initial IAA treatment modality (medical, PD, and surgery), were compared.
  
  
  RESULTS
  Thirty cases of IAA were identified (mean age at IAA diagnosis, 15.4 ± 2.6 yr, 67% female, median Crohn's disease duration, 2.6 mo). Computed tomography was the most common initial (93%) and follow-up (47%) imaging. The average time to follow-up imaging was 8.5 days. For initial management, 18 received medical therapy, 10 PD, and 2 had surgery. The medical therapy group received more computed tomography scans for follow-up imaging than the PD group (12 [67%] versus 2 [20%], P = 0.046). There were no significant differences in abscess characteristics or management of posttreatment course between these 2 groups. Surgical resection occurred in 3 patients (17%) in the medical group and 2 (20%) in the PD group during index hospitalization. No significant differences were identified among treatment groups for readmissions, complications, or abscess recurrence. By 1 year, 12 of the 18 medically managed patients (67%) had surgery, and 6 of the 10 patients (60%) treated with initial PD ultimately had surgery.
  
  
  CONCLUSIONS
  The majority of patients with IAA require definitive surgical treatment, and there were no clear predictors of those who did not.
authors: *Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio; †Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; ‡Pediatric Residency, Nationwide Children's Hospital, Columbus, Ohio; and §Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors: Jennifer L
authors: JL
authors: Dotson
authors: Hillary
authors: H
authors: Bashaw
authors: Benedict
authors: B
authors: Nwomeh
authors: Wallace V
authors: WV
authors: Crandall
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D019468:Disease Management; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed