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

Autoři	EL-HUSSUNA Alaa STEENHOLDT Casper KARER Mette Louise Merrild NIELSEN Natasja Nyggard Uldall MUJUKIAN Angela FLESHNER Phillip R IESALNIEKS Igors HORESH Nir KOPYLOV Uri JACOBY Harel AL-QAISI Haider Mahmoud COLOMBO Francesco SAMPIETRO Gianluca M MARINO Marco V ELLEBAK Mark SORENSEN Nina CELENTANO Valerio LADWA Nikhil WARUSAVITARNE Janindra PELLINO Gianluca ZEB Aurang CANDIDO Francesca Di HURTADO-PARDO Luis FRASSON Matteo KUNOVSKÝ Lumír YALCINKAYA Ali ALONSO Sandra PERA Miguel RODRÍGUEZ Cristina Antón ANA-MINAYA Bravo GRANERO Alvaro Garcia TATAR Ozan Can SPINELLI Antonino QVIST Niels
Rok publikování	2023
Druh	Článek v odborném periodiku
Časopis / Zdroj	Crohn's & colitis 360
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
www	https://academic.oup.com/crohnscolitis360/article/5/3/otad038/7226550
Doi	http://dx.doi.org/10.1093/crocol/otad038
Klíčová slova	Crohn’s disease; abscess; surgery; complications; stoma
Popis	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.