Abdominal abscesses in Crohn’s require surgery 70% of the time
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MAUI, Hawaii – Nearly a third of patients with Crohn’s disease will develop an abdominal abscess from a fistula during disease management. A presenter at the GUILD Conference reported that a surgical approach often produces better outcomes than medical therapy alone.
“One of the important aspects in terms of the success of medically treating this ... is can we treat the Crohn’s that develops an abscess with the medication or does this always require surgery?” Miguel Regueiro, MD, Cleveland Clinic division chief of gastroenterology and hepatology, said during his presentation. “The evidence of a stricture is of paramount importance. ... We need a view of a stricture below a fistula that’s leading to an abscess. That’s a high-pressure zone, that’s very unlikely to ever improve with medical therapy and often needs surgery.”
Regueiro reported that a Mayo Clinic study of medical treatments for an intra-abdominal abscess yielded positive results in short-term outcomes compared with surgery, but he argued the medical treatment may only delay inevitable surgery when the disease is irreversible.
In cumulative results, two-thirds of patients experienced abscess recurrence in the first 30 days with a higher recurrence rate in the medical treatment group. Only 36.4% of these patients were able to avoid surgery after 2 years.
Data from a more recent study showed size was another deciding factor in abscess management, according to Regueiro. Abscesses exceeding 6 cm and the presence of a prestenotic dilatation over 3 cm were unlikely to improve with medication in most patients.
While most data favor an near immediate surgical approach when treating internal fistulas and subsequent abscesses due to Crohn’s disease, there are patients who present with an internal fistula without an abscess and who improve while on medical therapy.
However, Regueiro said, “this represents about 30%. The other 70% will require surgery. What is important is if you see a patient with a stricture with prestenotic dilatation and an abscess. That’s the fixed complication that – in my humble opinion –no medication is ever going to treat.” – by Kate Burba
Reference: Regueiro M. How I Do It: Management of Intra-abdominal Abscess in Crohn’s Disease. Presented at: GUILD Conference; February 16-19, 2020; Maui, Hawaii.