Crohn's Disease-Related Abdominal and Pelvic Abscesses: Treatment Patterns and Outcomes

Abdominopelvic abscesses are significant complications in patients with Crohn's disease (CD), often necessitating individualized management approaches. This study evaluates real-world treatment patterns and outcomes of CD-related abdominopelvic abscesses.

This retrospective cohort study included adult patients with CD developing disease-related abdominopelvic abscesses between January 2017 and October 2021. Initial management was at the discretion of treating physicians and categorized as surgery, interventional radiology (IR)-guided procedures, or medical therapy. Patients were followed for 2 years. Primary outcomes included rates of salvage surgery and salvage IR-guided procedures, defined as additional unplanned treatment following the initial management approach. Secondary outcomes included any surgery within 2 years, including planned or delayed surgical intervention.

A total of 93 patients were included. Initial management included surgery in 25 (27%), IR-guided procedures in 35 (38%), and medical therapy alone in 33 patients (35%). Surgery was required in 60% within 2 years and 69% within 3 years. No variables were significantly associated with the need for surgery at 2 years on multivariable analysis. Salvage treatment was most frequent in the medical therapy group (39%) followed by IR (26%). Initial surgery was associated with presence of multiple abscesses (≥ 3 in 28% vs. 9% IR 3% medical; overall p = 0.047), while IR-drainage was associated with larger abscesses (median 5.0 cm [4-6]; overall p < 0.001) and prior abscesses (49% vs. 16%, p = 0.013).

Management of CD-related abscesses varies by complexity. High rates of salvage treatment and delayed surgery underscore the need for tailored approaches.