Initial Management of Intra-Abdominal Abscess in Crohn's Disease: A Systematic Review and Meta-Analysis

Intra-abdominal abscess (IAA) is a serious complication of Crohn's disease (CD). Management strategies include medical therapy, percutaneous drainage (PD), and initial surgery, but the optimal approach is debated. We performed a systematic review and meta-analysis to compare these strategies.

A systematic search of 4 electronic databases was conducted. The primary outcome was the need for surgical intervention (resection or reoperation). Secondary outcomes included recurrence and complications. Data were pooled using random-effects models.

Twenty-three studies were included. Compared with initial surgery, both PD (odds ratio [OR], 5.28; 95% confidence interval [CI], 1.65-16.91) and medical management (antibiotics alone ± corticosteroids) (OR, 4.40; 95% CI, 1.25-15.45) were associated with significantly higher odds of requiring surgical intervention, relative to the reoperation rate in the surgery group. PD was associated with significantly lower odds of overall postintervention complications compared with initial surgery (OR, 0.48; 95% CI, 0.23 to 0.96), with no significant difference in length of stay. Adjunctive exclusive enteral nutrition was associated with a significant reduction in the need for subsequent surgery (OR, 0.26; 95% CI, 0.10 to 0.67). Pooled proportions for requiring subsequent surgery were 48% for medical management, 47% for PD, and 21% for the reoperation rate in the initial surgical group.

Initial surgical management is the most definitive treatment for CD-related IAA, with the lowest reoperation rates. PD serves as a less invasive bridge to surgery that reduces postintervention complications. Medical management alone is less effective and should be reserved for select patients.