Evaluation of Long-Term Outcomes of Crohn's Disease Complicated by Intra-Abdominal Abscess: A Retrospective International Cohort Study.

Background

Crohn's disease complicated by intra-abdominal abscesses often requires surgery. Percutaneous drainage may prevent surgery, but optimal post-drainage management is unclear. We aimed to analyze the long-term outcomes of Crohn's disease with intra-abdominal abscesses after intervention.

Methods

Patients with penetrating Crohn's disease and a single intra-abdominal abscess were enrolled in this multicenter, international, retrospective study after the detection of the abscess (baseline), with a minimum follow-up of 12 months. Those requiring urgent bowel resection were excluded. Patients were grouped by elective surgical need after successful (catheter insertion with effective drainage) percutaneous drainage (controls: no pre-resection drainage). The primary outcome was abscess recurrence. We also assessed stoma rate, post-procedural complications, hospitalizations, advanced treatment need, postoperative luminal recurrence, and need for re-drainage.

Results

We studied 157 patients with Crohn's disease (9 countries; males: 58%, median age: 32.4 [interquartile range: 25-39 years]); 89/157 underwent percutaneous drainage (median follow-up: 95.9 weeks [interquartile range: 58-104]). Abscess recurrence did not differ by drainage (p = 0.221). Abscess size was associated with advanced-treatment initiation (Odds ratio: 0.978; 95% confidence interval: 0.960-0.997, p = 0.023) and postoperative luminal recurrence (Odds ratio: 1.044, 95% confidence interval: 1.012-1.078, p = 0.007). Time to resection was longer after drainage, and ROC analysis raised predictive value for re-drainage (16.6 weeks post-drainage; AUC = 0.82, 95% confidence interval: 0.73-0.92). Patients without drainage had more post-procedural complications.

Conclusions

Abscess size should guide management. Delayed resection may increase re-drainage odds, whereas surgery alone may have higher complication rates. Percutaneous drainage can safely postpone resection.