Background

Crohn’s disease (CD) is associated with the emergence of complications, including intra-abdominal abscess. Management is multidisciplinary based on close medical-surgical collaboration. The aim of the study was to evaluate the clinical characteristics, the efficacy of different therapeutic options of intra-abdominal abscess in CD patients and to identify predictive factors of a favorable response.

Methods

Medical records of 56 CD patients who had intra-abdominal abscess were retrospectively reviewed. Patients with postoperative abscess were excluded. Clinical, biological and therapeutic data were retrospectively assessed. Treatment progression was appreciated.IBM SPSS software 21.0 was used for statistical analysis of our data.

Results

In total, 897 patients were identified as having CD in the study period, 56 of them developed intra-abdominal abscess. Means that the prevalence of intra-abdominal abscess in CD patients was 6,2%.Mean age was 35,24 ± 11,6 years old with a sex ratio M/F 0,64. 47,3% had penetrating CD. 50.9% of our patients were known to be carriers of Crohn’s disease, 45% of whom were on 5-ASA, while the remaining patients 49.1% (n = 26), the abscess was inaugural and revealing of the CD.The clinical signs were dominated by pain in 80%, the abscess was localised mainly at the right iliac fossa in 77.7% of cases. Median size of collection was 3,8 ± 2 cm. There were 47,3% patients who had fistula associated to abscess. The initial reactive C protein ranged from 14 to 320 (median 58.3) mg/L.All patients had first-line treatment based on broad-spectrum bi-antibiotic therapy, alone in 25.5%, combined with surgical resection in 45.5%, surgical abscess drainage without resection in 23,6% or guided by imaging in 5.5%, the initial success was 71.7%. 28.3% of patients underwent surgery for initial treatment failure, which was dominated by ileocecal resection in 53.1%. Overall success was 92.3%, only one death was noted following postoperative release with peritonitis. Predictive factor of favorable response was: fistula associated with intra-abdominal abscess (p =0.03) and surgical resection seems to be the best therapeutic option (p < 0,001).

Conclusion

Intra-abdominal abscess is a complication of Crohn’s disease (CD) mainly penetrating, in almost half of the cases, it can reveal CD. Our study showed that the presence of fistula appears to be significantly associated with therapeutic success and the best results are obtained in the case of surgical resection.

中文翻译：

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P161克罗恩病腹腔内脓肿

背景

克罗恩氏病（CD）与并发症的出现有关，包括腹腔内脓肿。管理是基于紧密的医学-手术合作的多学科。这项研究的目的是评估CD患者的临床特征，腹腔内脓肿的不同治疗选择的疗效，并确定有利反应的预测因素。

方法

回顾性分析了56例腹腔内脓肿的CD患者的病历。术后脓肿患者被排除在外。回顾性评估临床，生物学和治疗数据。赞赏治疗的进展。IBMSPSS 21.0软件用于我们数据的统计分析。

结果

在研究期间，总共897例患者患有CD，其中56例发生腹腔内脓肿。意味着CD患者腹腔内脓肿的患病率为6.2％，平均年龄为35,24±11.6岁，性别比为M / F 0.64。47,3％的患者具有穿透CD。已知我们有50.9％的患者是克罗恩病的携带者，其中45％的患者使用5-ASA，而其余的患者为49.1％（n = 26），脓肿为就职且CD显露。疼痛占80％，脓肿主要集中在右侧窝，占77.7％。收集的中值大小为3.8±2厘米。有47,3％的患者患有与脓肿相关的瘘管。初始反应性C蛋白范围为14到320（中值58.3）mg / L。所有患者均接受基于广谱双抗生素治疗的一线治疗，单独治疗占25.5％，联合手术切除术占45.5％，不切除而无需手术的脓肿引流术占23.6％，或在影像学指导下占5.5％，初始成功率为71.7％。28.3％的患者因初次治疗失败而接受手术治疗，其中回盲肠切除占53.1％。总体成功率为92.3％，腹膜炎术后释放后仅死亡1例。良好反应的预测因素是：与腹腔内脓肿相关的瘘管（p = 0.03），外科手术切除似乎是最佳的治疗选择（p <0,001）。3％的患者因初始治疗失败而接受手术治疗，其中以回盲肠切除术占53.1％。总体成功率为92.3％，腹膜炎术后释放后只有1例死亡。良好反应的预测因素是：与腹腔内脓肿相关的瘘管（p = 0.03），外科手术切除似乎是最佳的治疗选择（p <0,001）。3％的患者因初始治疗失败而接受手术治疗，其中以回盲肠切除术占53.1％。总体成功率为92.3％，腹膜炎术后释放后只有1例死亡。良好反应的预测因素是：与腹腔内脓肿相关的瘘管（p = 0.03），外科手术切除似乎是最佳的治疗选择（p <0,001）。

结论

腹腔内脓肿是克罗恩氏病（CD）的主要并发症，在几乎一半的病例中，可以显示CD。我们的研究表明，瘘管的存在与治疗成功显着相关，在手术切除的情况下可获得最佳结果。