The clinical impact of preoperative percutaneous drainage of abdominopelvic abscesses in patients with Crohn's disease

Purpose Although image-guided percutaneous drainage is increasingly being used to treat Crohn's disease-related abdominopelvic abscesses, surgery is seldom avoided. The aimof this study was to compare outcomes following the treatment of intra-abdominal Crohn's abscesseswith percutaneous drainage followed by surgery to those after surgery alone. Methods We retrospectively reviewed the charts of patients treated for Crohn's-related abdominopelvic abscesses at Mount Sinai Medical Center between April 2001 and June 2010. Patients who underwent drainage followed by surgery were compared to those who underwent surgery alone. Differences in operative and postoperative outcomes were compared. Results Seventy patients with Crohn's disease-related abdominopelvic abscesses were identified, 38 (54%) of whom underwent drainage before surgery. Percutaneous drainage was technically successful in 92% of patients and clinically successful in 74% of patients. No differences in rate of septic complications (p=0.14) or need for stoma creation (p=0.78) were found. Patients who underwent percutaneous drainage had greater overall hospital lengths of stay (mean 15.8 versus 12.2 days, p=0.007); 8.6% of patients had long-term postponement of surgery after percutaneous drainage. Conclusions In our series, the treatment of Crohn's abscesses with percutaneous drainage prior to surgery did not decrease the rate of postoperative septic complications.