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Conservative management of spontaneous intra‐abdominal abscess in C rohn's disease: Outcome and prognostic factors
Author(s) -
Waked Bruno,
Holvoet Tom,
Geldof Jeroen,
Baert Filip,
Pattyn Piet,
Lobatón Triana,
Hindryckx Pieter
Publication year - 2021
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12984
Subject(s) - medicine , odds ratio , abscess , confidence interval , inflammatory bowel disease , surgery , retrospective cohort study , bowel resection , conservative management , resection , bowel obstruction , crohn's disease , disease , gastroenterology
Objective To compare the outcomes of different treatments for spontaneous intra‐abdominal abscesses (IAA) in active Crohn's disease (CD). Methods A retrospective analysis of patients with CD between January 2007 and December 2018 was performed in two Belgian inflammatory bowel disease centers. Successful conservative management was defined as complete resolution of abscesses without the need for bowel resection. The primary outcome was suboptimal evolution, defined as a composite outcome of recurrence of abscess, postoperative complications or the need for a non‐elective resection. Results Forty CD patients presenting with 43 independent episodes of spontaneous IAA development were included. One underwent immediate bowel resection. In all other 42 cases a conservative approach was taken, which led to a complete abscess resolution rate of 28.6% (12/42). The remaining abscesses required bowel resection. Anti‐tumor necrosis factor (TNF) agent use was associated with successful conservative management (odds ratio [OR] 13.36, 95% confidence interval [CI] 11.19‐15.52, P = 0.006), while the opposite trend was found for corticosteroids (OR 0.14, 95% CI 0.02‐1.26, P = 0.055). There was a trend towards suboptimal evolution in case of previous bowel resection (OR 4.77, 95% CI 0.77‐29.66, P = 0.094) or in patients aged above 50 years (OR 5.17, 95% CI 0.86‐30.91, P = 0.072). Conclusions Bowel resection appears to be inevitable in most CD patients presenting with IAA. An attempt at conservative treatment may be particularly successful with anti‐TNF agents in younger patients who have not undergone previous bowel resection. Large‐scale prospective studies are needed to confirm these findings.