MANAGEMENT OF INTRAABDOMINAL ABSCESSES IN CROHNS-DISEASE

Over a 5-year period, 54 intra-abdominal abscesses were observed in 40 (20.8%) of 192 patients with Crohn's disease. The median age was 39 y ears (range 17-76 years); median interval from diagnosis, 7.5 years (r ange 0-24 years) and the median number of surgical operations was 2 (r ange 0-7). Forty abscesses (74.1%) were spontaneous and 14 (25.9%) wer e postoperative. Thirty abscesses were initially managed by laparotomy , 14 by percutaneous drainage, nine by incision and drainage and in on e case the abscess drained spontaneously. Intra-abdominal abscesses we re managed successfully by laparotomy in 23 (76.7%) of 30 patients, wi th a 93% success rate (13 of 14) for spontaneous abscesses managed by resection and primary anastomosis. Three of 8 (37.5%) spontaneous absc esses were managed successfully by percutaneous drainage, a temporisin g effect being achieved in a further two cases. There was no significa nt difference in sepsis score or duration of hospital stay for patient s managed initially by laparotomy and those managed by drainage. Howev er, patients with stricturing or fistulating Crohn's disease were much more likely to have initial management by laparotomy and in these pat ients surgical intervention was found to be an effective initial strat egy.