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Percutaneous drainage of abdominal abscesses in pediatric Crohn's disease
Françoise Rypens1, Josée Dubois, Laurent Garel
1Department of Medical Imaging, Sainte-Justine Mother-Child University Hospital, 3175 Cote Sainte-Catherine Rd., Montreal, QC H3T 1C5, Canada. francoise_rypens@ssss.gouv.qc.ca
Insights
Percutaneous abscess drainage is a key treatment for pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Inflammatory Bowel Disease Management
Background:
- Crohn's disease affects 10-30% of patients with abscesses.
- Abscesses can be an initial or complicating factor in pediatric Crohn's disease.
Purpose of the Study:
- To evaluate the role of percutaneous abscess drainage in pediatric Crohn's disease patients.
- To demonstrate its efficacy as an adjunct to surgical treatment.
Main Methods:
- Retrospective study of 14 pediatric patients (12-17 years) with Crohn's disease and 15 abscesses.
- Percutaneous abscess drainage performed under CT or ultrasound guidance.
- Catheter drainage duration ranged from 1 to 30 days.
Main Results:
- Complete resolution in 8 abscesses, partial in 7.
- One complication: medically treated enterocutaneous fistula.
- Subsequent bowel resection with anastomosis feasible in 12 patients.
Conclusions:
- Percutaneous abscess drainage is valuable for pediatric Crohn's disease with abdominal/pelvic abscesses.
- Improves patient status and facilitates subsequent surgery.
- Recommended prior to definitive treatment.
Objective:
Crohn's disease is complicated by abscesses in 10-30% of patients during their lifetime. The goal of our study was to illustrate that, besides surgical treatment, percutaneous abscess drainage plays a major role in treating children with Crohn's disease.
Materials And Methods:
This retrospective study included 14 pediatric patients (age range, 12-17 years; median age, 15 years) with proven Crohn's disease. Percutaneous abscess drainage was performed for 15 abdominal or pelvic abscesses or for both abdominal and pelvic abscesses. The abscess was an initial manifestation of Crohn's disease in four patients and complicated well-known disease in 10 patients. Abscesses occurred spontaneously (n = 11), after surgery (n = 3), or after infliximab treatment (n = 1). Their volume ranged from 8 to 442 mL (mean, 113 mL). Fistulas with the bowel were detected in eight cases.
Results:
Sixteen percutaneous abscess drainages were performed under sonographic or CT guidance (or both) using 6- or 8-French catheters. The procedure was performed with the patient under conscious sedation (n = 14) or anesthesia (n = 2). The duration of the drainage was 1-30 days (mean, 11 days). An enterocutaneous fistula, medically treated with success, was the only complication observed. Complete resolution of the collection was observed in eight abscesses and partial resolution in seven. Resection of the diseased bowel segment with primary anastomosis was possible in 12 patients. In two patients, percutaneous abscess drainage was not followed by surgery.
Conclusion:
Percutaneous abscess drainage is a valuable procedure in pediatric patients with Crohn's disease presenting with pelvic or abdominal abscesses (or both). It improves the general status of the patient and allows a less invasive and easier subsequent surgical procedure. Percutaneous abscess drainage should be performed before definitive treatment.
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