Vascular and Interventional Radiology

Percutaneous Abscess Drainage in Crohn Disease: Technical Success and Short- and Long-term Outcomes during 14 Years

PURPOSE: To determine technical success with percutaneous abscess drainage (PAD) in patients with Crohn disease during 14 years.

MATERIALS AND METHODS: Medical records of 32 patients with Crohn disease who underwent PAD from 1985 to 1999 were reviewed. Results of abscess drainage and nature of subsequent surgical procedures were recorded. Factors assessed included postoperative or spontaneous nature of the abscess, documentation of a proved fistula, history of occurrence of prior abscesses, duration of Crohn disease, and use of steroid treatment. Technical success was defined as complete abscess drainage. Short-term success was defined as avoidance of surgery within 60 days of drainage. Long-term success was defined as avoidance of surgery beyond the initial 60-day period. Short-term avoidance of surgery was assessed as a predictor of the need for surgery in the long term. Statistical analysis was performed with the χ2 test to evaluate predictors of short-term success and to assess short-term success as a predictor of long-term success.

RESULTS: The technical success rate was 96%. In 16 (50%) of 32 patients, the need for surgery in the short term was avoided, and surgery was more likely to be avoided in patients with postoperative abscesses than in those with spontaneous abscesses (P = .07). At long-term follow-up, short-term avoidance of surgery did not significantly increase the likelihood of need for surgery in the long term, which occurred in nine of 16 short-term successes versus five of 15 short-term failures (P = .55). Recurrent abscesses occurred in seven (22%) patients, a rate comparable to that with surgical abscess drainage; four (44%) of nine cases of redrainage were successful.

CONCLUSION: PAD has a high technical success rate of 96%. Half of patients may avoid surgery in the short term.

© RSNA, 2002

References

  • 1 Nagler SM, Poticha SM. Intraabdominal abscess in regional enteritis. Am J Surg 1979; 137:350-354. Crossref, MedlineGoogle Scholar
  • 2 Steinberg DM, Cooke WT, Alexander-Williams J. Abscess and fistulae in Crohn’s disease. Gut 1973; 14:865-869. Crossref, MedlineGoogle Scholar
  • 3 Edwards H. Crohn’s disease: an inquiry into its nature and consequences. Ann R Coll Surg Engl 1969; 44:121-139. MedlineGoogle Scholar
  • 4 Greenstein AJ, Kark AE, Dreiling DA. Crohn’s disease of the colon. Am J Gastroenterol 1974; 62:419-425. MedlineGoogle Scholar
  • 5 Keighley MRB, Eastwood D, Ambrose NS, Allan RN, Burdon DW. Incidence and microbiology of abdominal and pelvic abscess in Crohn’s disease. Gastroenterology 1982; 83:1271-1275. Crossref, MedlineGoogle Scholar
  • 6 Casola G, vanSonnenberg E, Neff CC, Saba RM, Withers C, Emarine CW. Abscesses in Crohn disease: percutaneous drainage. Radiology 1987; 163:19-22. LinkGoogle Scholar
  • 7 Safrit HD, Maura MA, Jaques PF. Percutaneous abscess drainage in Crohn’s disease. AJR Am J Roentgenol 1987; 148:859-862. Crossref, MedlineGoogle Scholar
  • 8 Lambiase RE, Cronan JJ, Dorfman GS, Paolella LP, Haas RA. Percutaneous drainage of abscesses in patients with Crohn disease. AJR Am J Roentgenol 1988; 150:1043- 1045. Crossref, MedlineGoogle Scholar
  • 9 Doemeny JM, Burke DR, Meranze SG. Percutaneous drainage of abscesses in patients with Crohn’s disease. Gastrointest Radiol 1988; 13:237-241. Crossref, MedlineGoogle Scholar
  • 10 Millward SF, Ramsewak W, Fitzsimons P, Frost R, Tam P, Toi A. percutaneous drainage of iliopsoas abscess in Crohn’s disease. Gastrointest Radiol 1986; 11:289-290. Crossref, MedlineGoogle Scholar
  • 11 Jawhari A, Kamm MA, Ong C, Forbes A, Bartram CI, Hawley PR. Intra-abdominal and pelvic abscess in Crohn’s disease: results of non-invasive and surgical management. Br J Surg 1998; 85:367-371. Crossref, MedlineGoogle Scholar
  • 12 Ayuk P, Williams N, Scott NA, Nicholson DA, Irving MH. Management of intra-abdominal abscesses in Crohn’s disease. Ann R Coll Surg Engl 1996; 78:5-10. MedlineGoogle Scholar
  • 13 Sahai A, Belair M, Gianfelice D, Cote S, Gratton J, Lahaie R. Percutaneous drainage of intra-abdominal abscess in Crohn’s disease: short and long term outcome. Am J Gastroenterol 1996; 92:275-278. Google Scholar
  • 14 vanSonnenberg E, Mueller PR, Ferrucci JT. Percutaneous drainage of 250 abdominal abscesses and fluid collections. I. results, failures, and complications. Radiology 1984; 151:337-341. Google Scholar
  • 15 Mueller PR, vanSonnenberg E, Ferrucci JT. Percutaneous drainage of 250 abdominal abscesses and fluid collections. II. Current procedural concepts. Radiology 1984; 151:343-347. Google Scholar
  • 16 Krupnick AS, Morris JB. The long-term results of resection and multiple resections in Crohn’s disease. Semin Gastrointest Dis 2000; 11:41-51. MedlineGoogle Scholar
  • 17 Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis. JAMA 1932; 99:1323-1329. CrossrefGoogle Scholar
  • 18 Greenstein AJ, Sacher DB, Greenstein RJ, et al. Intraabdominal abscess in Crohn’s ileocolitis. Am J Surg 1982; 143:727-730. Crossref, MedlineGoogle Scholar
  • 19 Rice MA, Meyer KK. Psoas abscess complication Crohn’s disease. Am J Gastroenterol 1985; 80:970-977. MedlineGoogle Scholar

Article History

Published in print: Mar 2002