title: Role of percutaneous abscess drainage in the management of young patients with Crohn disease.
abstract: BACKGROUND
  Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited.
  
  
  OBJECTIVE
  Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy.
  
  
  METHODS
  We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure.
  
  
  RESULTS
  All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01).
  
  
  CONCLUSIONS
  Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection.
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. Brian.Pugmire@cchmc.org.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Pugmire
authors.affiliation: Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA.|Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Gee
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Jess L
authors.initials: JL
authors.lastname: Kaplan
authors.affiliation: Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hahn
authors.affiliation: Department of Surgery, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Doody
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Harland S
authors.initials: HS
authors.lastname: Winter
authors.affiliation: Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Gervais
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000601:surgery*; D000293:Adolescent; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Abscess; Children; Crohn disease; Gastrointestinal tract; Interventional radiology; Percutaneous drainage
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