Outcome of Medical Management of Intra-Abdominal Abscesses in Children with Crohn's Disease

• Published in: Journal of pediatric surgery 2017
• Main Authors: Alkhouri, Razan H, Bahia, Gracielle, Smith, Ashley C, Thomas, Richard, Finck, Christine, Sayej, Wael
• Format: Article
• Language: English
• Subjects: Pediatrics; Surgery
• ISSN: 0022-3468
• DOI: 10.1016/j.jpedsurg.2017.03.059

Abstract Introduction Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that is complicated by fistulas, strictures, and Intra-abdominal abscesses (IAA) in 10–30% of patients. To avoid surgical resection of the bowel, medical therapy with antibiotics (Ab) with or without percutaneous drainage (PD) are first undertaken. Our objectives are to examine the outcome of IAA in CD patients treated with antibiotics alone vs antibiotics and PD, and to identify risk factors for medical therapy failure. Methods Charts for patient with CD who were diagnosed between 2004–2016 at the Women and Children's Hospital of Buffalo were retrospectively reviewed. We compared the two modalities of medical therapy (Ab + PD vs Ab alone) in terms of abscess resolution and the need for surgical intervention. Results Twenty-nine patients, ages ranged from 12 to 18 years, mean 15.5 ± 2.5, 48% Male with IAA were identified. Overall, 69% of abscesses failed medical therapy including 87% of the drained abscesses and 50% of non-drained abscesses, p = 0.04. The abscesses that failed medical therapy were more likely to have been drained ( P = 0.03) as they were larger in size (P = 0.03), patients were more likely to be a known CD on immunosuppression (P = 0.016), more likely to have an associated upper GI disease (P = 0.002), when compared to those that were successful with medical therapy alone. Conclusion Our results show that the majority of our patients required surgical intervention for abscess treatment and resolution of associated findings despite drainage. Risk factors include big drainable abscesses, developing IAA while on immunosuppression, and a more extensive disease with associated fistulae and strictures. Small undrainable abscesses are likely to resolve with antibiotics alone, therefore early detection and treatment is essential. Type of Study Level 2, retrospective study.