Percutaneous drainage of intra-abdominal abscesses in Crohn's disease: short and long-term outcome.

OBJECTIVE

To determine whether percutaneous drainage of Crohn's abscesses obviates the need for early surgical drainage.

METHODS

All cases of percutaneous drainage of Crohn's abscesses between 1990 and 1995 were reviewed and classified as a success or failure on the basis of the need for surgery within < 30 days of catheter removal.

RESULTS

Twenty-seven drainage procedures were performed in 24 patients; 15 (56%) were classified as successes, and 12 (44%) were classified as failures. Successes and failures did not significantly differ with respect to patient demographics and Crohn's disease characteristics. Patients whose abscesses were successfully drained had significantly fewer associated fistulae (46.6 vs 92.0%, p = 0.037), and their abscesses tended more often to be first (vs recurrent), spontaneous (vs postoperative), located in the right lower quadrant, and smaller. Patients whose abscesses were successfully drained also tended to spend more time with the catheter in place and to require more imaging procedures. Complications were noted in four cases (15%), enterocutaneous fistula at the site of catheter insertion in three cases and postprocedure fever in one case. Hospital stay was significantly shorter after successful drainage (16.3 +/- 6.9 vs 31.7 +/- 22.1 days, p = 0.017). After a total of 543.5 patient-months of follow-up, subsequent intra-abdominal Crohn's-related surgery was required in only two of the successes and one failure.

CONCLUSIONS

1. Percutaneous drainage of Crohn's abscess successfully obviates the need for early surgery in approximately 50% of cases, and this benefit is maintained on long term follow-up. 2) Percutaneous drainage shortens hospital stay. 3) Crohn's abscesses in various locations, single or multiple, with or without an associated fistula may be successfully drained percutaneously. 4) Presence of an associated fistula may be a risk factor for failure.