Division of Gastroenterology and Hepatology, VA North Texas Health Care System, and the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Clin Gastroenterol Hepatol. 2011 Oct;9(10):842-50. doi: 10.1016/j.cgh.2011.04.023. Epub 2011 May 5.
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.
克罗恩病的特征是累及肠壁全层的炎症，可导致严重并发症，包括腹腔和盆腔脓肿。腹腔脓肿合并活动性克罗恩病给治疗医生带来了特殊的困境，医生必须权衡使用免疫抑制疗法治疗炎症性肠病的益处与在严重腹部感染存在的情况下免疫抑制的风险。传统上，与克罗恩病相关的脓肿采用早期手术治疗，这通常涉及外部引流程序、肠切除术和在急性病患者中创建转流造口。如今，此类脓肿通常可以先通过抗生素和经皮引流来治疗，选择性地对某些患者进行延迟手术。通过选择性地进行延迟手术，外科医生通常可以切除患病的肠道并创建一期吻合术，从而避免急诊手术和多阶段手术。在高度选择的情况下，可能完全避免手术。本报告回顾了克罗恩病（包括经皮引流、免疫抑制治疗和手术）腹腔脓肿的病理生理学和治疗方面的文献，并提供了一种处理这一难题患者的建议方法。
