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. 2021 Mar 5;15(3):409-418.
doi: 10.1093/ecco-jcc/jjaa217.

A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort

M K Collard  1 , S Benoist  1 , L Maggiori  2 , P Zerbib  3 , J H Lefevre  4 , Q Denost  5 , A Germain  6 , E Cotte  7 , L Beyer-Berjot  8 , H Corté  9 , V Desfourneaux  10 , A Rahili  11 , J P Duffas  12 , K Pautrat  13 , C Denet  14 , V Bridoux  15 , G Meurette  16 , J L Faucheron  17 , J Loriau  18 , R Souche  19 , E Vicaut  20 , Y Panis  2 , A Brouquet  1
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A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort

M K Collard et al. J Crohns Colitis. .

Abstract

Background and aims: Few prospective data exist on outcomes of surgery in Crohn's disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage.

Methods: From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups.

Results: Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159].

Conclusions: Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.

Keywords: Ileocolonic Crohn’s disease; ileocolonic resection; intra-abdominal abscess.

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