Intra-abdominal abscesses in Crohn's disease: diagnosis and therapeutic management

Introduction: Intra abdominal abscess in Crohn's disease is a rare complication. Its management presents diagnostic and therapeutic problems. Aim of the study: To evaluate our management of patients with intra abdominal abscess as a complication of Crohn's disease and propose a diagnostic and therapeutic strategy. Method: Retrospective study of 32 cases of Crohn's disease complicated by intra abdominal abscess were admitted to our department between 1995 and 2007. Method: Retrospective study of 32 cases of Crohn's disease complicated by intra abdominal abscess were admitted to our department between 1995 and 2007. Results: The study examined 10 men (32%) and 22 women (68%), the average age was 31 +/- 9.91 years. The abscess inaugurated Crohn's disease in 10 cases (32%), in the other cases (68%) the diagnosis of Crohn's disease had already been made. The Crohn's disease was ileocecal in 31 cases (98%), and colic in one case. The clinical presentation was not specific, local abdominal guarding was found in only one patient (3%). A high level of leucocytes was found in 81% of the cases and a high level of C-reactive protein in all cases (100%). Twenty patients in the study were explored by abdominal ultra sound (62%) which sensibility was about 55% for the abscess diagnosis. An abdominal scan was made on 29 patients (71%) for the abscess diagnosis; the average size of the abscess was about 5.2 cm. The abscess was treated by antibiotherapy In 15 cases (47%) with success in 80% of the cases and in 17 cases (53%) by a radiological percutaneous drainage with success in 89% of the cases. The percutaneous drainage was removed after a mean of 22 +/- 16 days. Colonoscopy and barium meal showed an associated intestinal stenosis in 31 cases inducing an intestinal resection. In one case, the stenosis was small and the patient was not operated after the treatment of the abscess; the evolution showed a recidivate abscess after one year. The surgical procedure consisted in: an ileocecal resection in 31 cases, by a laparoscopic approach in 7 cases and in one case a total colectomy with an ileo-rectal anastomosis was performed. Surgical complications occurred in 6 cases (18%) Conclusion: When an intra abdominal abscess is suspected for patients with Crohn's disease, the diagnosis approach must be based directly on the abdominal CT scan. The therapeutic approach must be based on a percutaneous drainage first, followed by a resection in the presence of a persistent fistula or intestinal stenosis. This resection could be done by laparoscopic surgery when possible.