TY - JOUR
T1 - Current strategies in the management of intra-abdominal abscesses in crohn's disease
AU - Feagins, Linda A.
AU - Holubar, Stefan D.
AU - Kane, Sunanda V.
AU - Spechler, Stuart J.
N1 - Funding Information:
Conflicts of interest The authors disclose the following: L.A. Feagins has grant support from Centocor . S. Kane is a consultant for Abbott, Elan, UCB, Kyorin, and Millenium, and has grant support from Elan , Shire , and Warner Chilcott . The remaining authors disclose no conflicts.
Funding Information:
Funding This work was supported by the Office of Medical Research, Department of Veteran's Affairs (Dallas, Texas; L.A. Feagins) and the Harris Methodist Health Foundation, Dr Clark R. Gregg Fund (L.A. Feagins).
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/10
Y1 - 2011/10
N2 - Crohn's disease is characterized by inflammation that involves the full thickness of the bowel wall, which can lead to serious complications including intra-abdominal and pelvic abscesses. The combination of an intra-abdominal abscess with active Crohn's disease poses a particular dilemma for the treating physician, who must weigh the benefits of using immunosuppressive therapies for the inflammatory bowel disease against the risks of immunosuppression in the presence of serious abdominal infection. Traditionally, Crohn's-related abscesses were managed with early surgery, which often involved external drainage procedures, bowel resection, and the creation of diverting ostomies in acutely ill patients. Today such abscesses often can be managed initially with antibiotics and percutaneous drainage, with evaluation for the need for delayed surgery in selected patients. With delayed surgery performed electively, the surgeon frequently can resect the diseased bowel and create a primary anastomosis, thus avoiding emergency operations and multistage procedures. In highly selected cases, surgery might be avoided entirely. This report reviews the literature on the pathophysiology and management of intra-abdominal abscesses in Crohn's disease (including the roles of percutaneous drainage, immunosuppressive therapy, and surgery), and provides a suggested approach to the management of patients with this difficult problem.
AB - Crohn's disease is characterized by inflammation that involves the full thickness of the bowel wall, which can lead to serious complications including intra-abdominal and pelvic abscesses. The combination of an intra-abdominal abscess with active Crohn's disease poses a particular dilemma for the treating physician, who must weigh the benefits of using immunosuppressive therapies for the inflammatory bowel disease against the risks of immunosuppression in the presence of serious abdominal infection. Traditionally, Crohn's-related abscesses were managed with early surgery, which often involved external drainage procedures, bowel resection, and the creation of diverting ostomies in acutely ill patients. Today such abscesses often can be managed initially with antibiotics and percutaneous drainage, with evaluation for the need for delayed surgery in selected patients. With delayed surgery performed electively, the surgeon frequently can resect the diseased bowel and create a primary anastomosis, thus avoiding emergency operations and multistage procedures. In highly selected cases, surgery might be avoided entirely. This report reviews the literature on the pathophysiology and management of intra-abdominal abscesses in Crohn's disease (including the roles of percutaneous drainage, immunosuppressive therapy, and surgery), and provides a suggested approach to the management of patients with this difficult problem.
KW - Abscess
KW - Crohn's Disease
KW - Inflammatory Bowel Disease
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U2 - 10.1016/j.cgh.2011.04.023
DO - 10.1016/j.cgh.2011.04.023
M3 - Article
C2 - 21679776
AN - SCOPUS:80053132799
SN - 1542-3565
VL - 9
SP - 842
EP - 850
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 10
ER -