Comparison of the long‐term outcome of two therapeutic strategies for the management of abdominal abscess complicating C rohn's disease: percutaneous drainage or immediate surgical treatment

Aim The management of abdominal abscesses complicating C rohn's disease is complex and involves a difficult choice between medical, radiological and surgical procedures. The long‐term outcome was compared for two strategies for the management of abdominal abscess: percutaneous drainage ( PD ) followed by rescue surgery in the case of failure vs direct immediate surgery ( IS ). We also compared the results of IS with surgery performed after PD failure. Methods We retrospectively identified 44 patients with C rohn's disease with an abdominal abscess from J anuary 2000 to D ecember 2009. Therapeutic success was defined as abscess resolution and no reappearance within 1 year of follow‐up. Results The first therapeutic approach was PD in 22 cases and IS in the other 22 cases. IS had a higher therapeutic success rate than PD (95.5% vs 27.2% respectively; P  <   0.001). PD was the only independent variable related to treatment failure in the multivariate analysis after adjustment for possible confounders such as abscess size, multilocularity, presence of fistula and corticosteroid use ( OR 88.26, 95% CI 7.38–1055.36; P  <   0.001). Surgery after failure of PD ( n  =   16) was associated with longer total hospitalization (56.12 ± 35.89 vs 27.52 ± 15.11 days; P  =   0.017) and longer postoperative stay (44.0 ± 83.7 vs 14.3 ± 30 days; P  =   0.179) and needed a second operation more often (5/16, 31% vs 1/22, 4.5%; P  =   0.065) than IS . Conclusions Percutaneous drainage provided durable abscess resolution in only one‐third of the patients compared with more than 90% of those treated with IS . In addition, surgery performed after PD failure results in a poorer outcome than IS .