Role of Percutaneous Drainage for Disease-Related Abscesses

Abstract

Introduction: Intra-abdominal abscesses can occur in up to 20% of patients with Crohn’s disease. There is no consensus on the optimal management of this complication, despite a number of proposed treatment approaches. The aim of this chapter is to discuss the literature regarding the management of intra-abdominal abscesses in Crohn’s disease with respect to post-procedural complications and the cost-effectiveness of these interventions.

Methods: The EMBASE and MEDLINE databases were queried for all studies between 2000 and 2018 on the surgical and percutaneous management of intra-abdominal abscesses in Crohn’s disease. Studies examining post-procedural complications and the cost-effectiveness of these interventions were included for analysis. The quality of the included studies was analyzed using the Newcastle-Ottawa scale.

Results: Ten studies were identified for inclusion. This comprised eight observational studies and two meta-analyses. There was significant heterogeneity of the individual studies with regard to post-operative complications. The meta-analyses identified an increased risk of post-operative complications in patients treated with “surgery alone” versus “percutaneous drainage + surgery” (OR = 0.44 95% CI 0.23–0.83, p = 0.01) and an increased stoma creation with “surgery alone” versus “percutaneous drainage + surgery” (OR = 0.44 95% CI 0.21–0.91, p = 0.03). There was an increased abscess recurrence in those treated with “percutaneous drainage alone” versus “surgery alone” (OR = 6.544, 95% CI: 1.783–24.010, p = 0.005). Patients treated with “percutaneous drainage + surgery” were more cost-effective than those treated with “surgery alone.”

Conclusions: Newly presenting intra-abdominal abscesses should be considered for radiological drainage with the intention of an interval surgical resection of the associated diseased bowel. This may reduce the risk of post-operative complications and stoma creation. Although surgical resection may be avoided in one-third of patients treated with percutaneous drainage, this should not be the goal of therapy with the currently available data.