Watchful Waiting after Radiological Guided Drainage of Intra-abdominal Abscess in Patients with Crohn's Disease Might Be Associated with Increased Rates of Stoma Construction

Alaa El-Hussuna*, Casper Steenholdt, Mette Louise Merrild Karer, Natasja Nyggard Uldall Nielsen, Angela Mujukian, Phillip R. Fleshner, Igors Iesalnieks, Nir Horesh, Uri Kopylov, Harel Jacoby, Haider Mahmoud Al-Qaisi, Francesco Colombo, Gianluca M. Sampietro, Marco V. Marino, Mark Ellebæk, Nina Sørensen, Valerio Celentano, Nikhil Ladwa, Janindra Warusavitarne, Gianluca PellinoAurang Zeb, Francesca Di Candido, Luis Hurtado-Pardo, Matteo Frasson, Lumir Kunovsky, Ali Yalcinkaya, Sandra Alonso, Miguel Pera, Cristina Antón Rodríguez, Ana Minaya Bravo, Alvaro Garcia Granero, Ozan Can Tatar, Antonino Spinelli, Niels Qvist

*Autor correspondiente de este trabajo

Producción científica: Contribución a una revistaArtículoInvestigaciónrevisión exhaustiva

Resumen

Background: Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn's disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods: This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results: Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions: Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors.
Idioma originalInglés
Número de artículootad038
Número de páginas4
PublicaciónCrohn's and Colitis 360
Volumen5
N.º3
DOI
EstadoPublicada - jul 2023

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