Abscesses in Crohn's disease - Outcome of medical versus surgical treatment

Goals: To compare the long-term outcome of medical, percutaneous, and surgi cal treatment of abdominal and pelvic abscesses complicating Crohn's diseas e. Study: All patients with Crohn's disease and an abdominal abscess treate d at one institution during a 10-year period were retrospectively identifie d. We reviewed hospital and outpatient records and contacted patients for t elephone interviews. Outcome measures included abscess recurrence, subseque nt surgery for Crohn's disease, and medications used at the time of most re cent follow-up. Results: Fifty-one subjects were identified, with a mean fo llow-up of 3.75 years. Fewer patients developed recurrent abscesses after i nitial surgical drainage and bowel resection (12%) than patients treated wi th medical therapy only or percutaneous drainage (56%) (p = 0.016). One hal f of the patients treated nonoperatively ultimately required surgery, where as only 12% of those treated with initial surgery required reoperation duri ng the follow-up period(p = 0.010). Most failures of nonoperative therapy o ccurred within 3 months. Medication use was similar between the treatment g roups at the time of most recent follow-up. Conclusions: In this series, su rgical management of abscesses in Crohn's disease was more effective than m edical treatment or percutaneous drainage for prevention of abscess recurre nce. However, nonoperative therapy prevented subsequent surgery in half of the patients and may be a reasonable treatment option for some patients.