Intraabdominal abscesses in patients with Crohn's disease: Clinical data and therapeutic manipulations in 17 cases of a single hospital setting

Abstract

Aim: To describe the clinicoepidemiological data and therapeutic manipulation in 17 patients with Crohn's disease who developed intraabdominal abscesses during a period of twelve years. Patients and Methods: There were 9 men and 8 women aged 31+/-10 years. The underlying intestinal disease was located in the small bowel in all cases except for four in which the small and large bowel was concurrently affected.The duration of disease was 6.7+/-4.0 and 4.6+/-2.4 years at the time of data analysis and the appearance of complication, respectively. Results: Abdominal pain, fever, and palpable abdominal mass were the main clinical findings. Signs of enterovesicular fistula and symptoms of incomplete large bowel obstruction were noticed in two and two patients,respectively. In three patients the abscess was diagnosed at the time of infliximab (Remicade) and in one during adalimumab (Humira), the anti-tumor necrosis-alpha monoclonal antibodies, administration. Abdominal computed tomography and transdermal abdominal ultrasonography were the most useful diagnostic procedures applied. Surgical drainage of the abscess was considered as the therapeutic method of choice and subsequently was applied in all patients. In half of them segmental enterectomy and end-to-end anastomosis was also performed within months after drainage. Postsurgical morbidity was generally low. In three patients the abscess reappeared during the follow-up period. Conclusion: Intraabdominal abscess is a severe complication appearing in a proportion of patients with Crohn's disease mainly with terminal ileum involvement. Surgical drainage is the procedure of choice. Segmental enterectomy and end-to-end anastomosis is necessary in most of them after drainage. Intraabdominal abscess can be manifested during treatment with biologic agents (infliximab and adalimumab).