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Outcome of surgical and
medical treatment of abscess
in Crohn’s disease
Prof Dr Nasir Khokhar MD FACP FACF
Professor and C...
Pathogenesis
 Spontaneous or post operative
 10-30% patients develop spontaneous
abscesses in their lifetime
 Occur due...
Pathogenesis of abscess
Clinical presentation and diagnosis
• History, physical examination and imaging:
Elderly and immunosuppressed may not show...
Rectal Abscess
Thick walled pelvic abscess
Intra abdominal abscess
CT guided PAD
• Clinical status: No peritonitis and
hemodynamically stable: Appropriate antibiotics
• PAD initial choice: ...
Outcome of PAD
• Success: Resolution of symptoms, collapse of
abscess cavity and avoidance of early surgery
(30-60 days)
•...
Timing of surgery after PAD
• Controversial: Do all need surg after PAD?
Residual bowel disease: only 23%
avoided surgery ...
Outcome of surgery and PAD
Summary
• Spontaneous abscess in 10-30% patients
with Crohn’s disease in their lifetime
• PAD is first choice: Surgery aft...
Famous people with Crohns
Thanks for patient listening
Outcome of abscess treatment in Crohn's disease
Outcome of abscess treatment in Crohn's disease
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Outcome of abscess treatment in Crohn's disease

  1. 1. Outcome of surgical and medical treatment of abscess in Crohn’s disease Prof Dr Nasir Khokhar MD FACP FACF Professor and Chief of Gastroenterology Shifa International Hospital, Islamabad
  2. 2. Pathogenesis  Spontaneous or post operative  10-30% patients develop spontaneous abscesses in their lifetime  Occur due to transmural inflammation and micro perforation of diseased bowel  Most common locations: abd wall, rectus sheath, ileo paoas muscle, gluteal Yamaguchi A, Matsui T, Sakurai T, Ueki T, Nakabayashi S, Yao T,. The clinical characteristics outcome of intraabdominal abscess in Crohn’s disease. J Gastroenterol 2004;39:441-8
  3. 3. Pathogenesis of abscess
  4. 4. Clinical presentation and diagnosis • History, physical examination and imaging: Elderly and immunosuppressed may not show symptoms • Spiral CT • CT enterography; may demonstrate fistula and extent and degree of bowel wall inflammation: Inflammatory mass: phlegmon. Well defined border: abscess • Aspiration of pus Gutierrez A, Lee H, Sands BE. Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn’s disease. Am J Gastroenterol 2006; 101: 2283-2289
  5. 5. Rectal Abscess
  6. 6. Thick walled pelvic abscess
  7. 7. Intra abdominal abscess
  8. 8. CT guided PAD • Clinical status: No peritonitis and hemodynamically stable: Appropriate antibiotics • PAD initial choice: Advantages; Delayed surg until sepsis controlled, nutrition improved and steroids tapered • Drain as much pus; Size <3 cm only antibiotics ok • Approaches: Transgluteal, transabdominal, perineal, transrectal, transvaginal • EUS or laparoscopic approach Poritz LS, Koltun WA. Percutaneous drainage and ileoco- lectomy for spontaneous intraabdominal abscess in Crohn’s disease. J Gastrointest Surg 2007; 11: 204-208
  9. 9. Outcome of PAD • Success: Resolution of symptoms, collapse of abscess cavity and avoidance of early surgery (30-60 days) • Success rate 50-95% • Poor outcome: Multiple or multilocular abscesses, Associated fistula, spontaneous vs postoperative (77% vs 83%) • In failure, a sinogram will show fistlua and will need surgery Golfieri R, Cappelli A. Computed tomography-guided per-cutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol 2007; 11: 197-208
  10. 10. Timing of surgery after PAD • Controversial: Do all need surg after PAD? Residual bowel disease: only 23% avoided surgery after 7 year FU • Success in 84% after 7 days: Many wait 6- 8 weeks • Nutritional status important for surgery • Risk of dehiscence, if patient on steroids for >3 months Cellini C, Safar B, Fleshman J. Surgical management of pyogenic complications of Crohn’s disease. Inflamm Bowel Dis 2010; 16: 512-517
  11. 11. Outcome of surgery and PAD
  12. 12. Summary • Spontaneous abscess in 10-30% patients with Crohn’s disease in their lifetime • PAD is first choice: Surgery afterwards • Multiple abscesses and fistulae need surgery • Malnutrition and steroids lead to poor outcome • Highly skilled team of gastroenterologists, surgeons and interventional radiologists is required
  13. 13. Famous people with Crohns
  14. 14. Thanks for patient listening

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