Research Article

Percutaneous abdomino-pelvic abscess drainage in complicated Crohn’s disease

Alberta Cappelli*, Silvio Laureti, Nunzia Capozzi, Cristina Mosconi, Francesco Modestino, Giuliano Peta, Silvia Lo Monaco, Antonio Bruno, Giulio Vara, Caterina De Benedittis, Paolo Gionchetti, Fernando Rizzello, Gilberto Poggioli and Rita Golfieri

Published: 10/05/2020 | Volume 4 - Issue 1 | Pages: 045-051

Abstract

Purpose: Percutaneous abscess drainage (PAD) is the first-line approach for abscess in Crohn’s disease (CD) since it procrastinates or avoids surgery especially in postoperative abscesses [within 30 days post-operative (p.o.)]. We retrospectively evaluated the effectiveness, complications and outcome after PAD in postoperative and spontaneous abscesses and factors influencing the outcomes.

Methods: We performed PAD in 91 abscesses, 45 (49,5%) postoperative and 46 (50,5%) spontaneous.

We defined the overall success (OS) as clinical (CS) and technical success (TS) when imaging documented the resolution of the abscess with no surgery within 30 days.
Conversely, patients without abscess at the time of surgery, were considered as TS but clinical failure (CF).

We also analyzed the overall failure (OF) defined as CF with or without technical failure (TF).

Overall technical success (OTS) was OS plus TS. Complications were classified as major and minor according to the Interventional Radiology Criteria.

Results: In postoperative abscesses we found 91% OS, 9% OF, no TF and 100% OTS.
In spontaneous abscesses we found 33% OS, 67% OF, 6.4% TF, 95,6% OTS.

A total abscess resolution was achieved in 97,8% of patients. No major complication occurred; only 1 case of minor complication. Factors statistically influencing the outcome were postoperative vs spontaneous collections (OF: 9% vs. 67%, p < 0.0001), multiloculated vs uniloculated collections (OF: 38% vs. 1%, p < 0.0001) and upper abdominal vs lower location (OF: 13% vs. 25%, p <0.05).

Conclusion: Our data confirms the safety and effectiveness of PAD even in cases needing surgery within 30 days; most remarkable, PAD allows avoidance of early reoperation in almost all the patients with postoperative abscess.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001022 Cite this Article

References

  1. Xie Y, Zhu W, Li N, Li J. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn’s disease. Int J Colorectal Dis. 2012; 27: 199-206. PubMed: https://pubmed.ncbi.nlm.nih.gov/22052039/
  2. de Groof EJ, Carbonnel F, Buskens CJ, Bemelman WA. Abdominal abscess in Crohn’s disease: multidisciplinary management. Dig Dis. 2014; 32: 103-109. PubMed: https://pubmed.ncbi.nlm.nih.gov/25531361/
  3. Patil SA, Cross RK. Medical versus surgical management of penetrating Crohn’s disease: the current situation and future perspectives. Expert Rev Gastroenterol Hepatol. 2017; 11: 843-848. PubMed: https://pubmed.ncbi.nlm.nih.gov/28633544/
  4. Bafford AC, Coakley B, Powers S, Greenwald D, Ha CY, Weintraub JM et al. The clinical impact of preoperative percutaneous drainage of abdominopelvic abscesses in patients with Crohn’s disease. Int J Colorectal Dis. 2012; 27: 953-958. PubMed: https://pubmed.ncbi.nlm.nih.gov/22249438/
  5. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn’s disease. Lancet 2017; 389: 1741-1755. PubMed: https://pubmed.ncbi.nlm.nih.gov/27914655/
  6. Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s disease. Dis Mon. 2018; 64: 20-57. PubMed: https://pubmed.ncbi.nlm.nih.gov/28826742/
  7. da Luz Moreira A, Stocchi L, Tan E, Tekkis PP, Fazio VW. Outcomes of Crohn’s disease presenting with abdominopelvic abscess. Dis Colon Rectum. 2009; 52: 906-912. PubMed: https://pubmed.ncbi.nlm.nih.gov/19502855/
  8. Clancy C, Boland T, Deasy J. A Meta-analysis of Percutaneous Drainage Versus Surgery as the Initial Treatment of Crohn’s Disease-related Intra-abdominal Abscess. J Crohns Colitis. 2016; 10: 202-208. PubMed: https://pubmed.ncbi.nlm.nih.gov/26512133/
  9. Golfieri R, Cappelli A, Giampalma E, Rizzello F, Gionchetti P, et al. CT-guided percutaneous pelvic abscess drainage in Crohn’s disease. Tech Coloproctol. 2006; 10: 99-105. PubMed: https://pubmed.ncbi.nlm.nih.gov/16773292/
  10. Pugmire BS, Gee MS, Kaplan JL, Hahn PF, Doody DP, et al. Role of percutaneous abscess drainage in the management of young patients with Crohn disease. Pediatr Radiol. 2016; 46: 653-659. PubMed: https://pubmed.ncbi.nlm.nih.gov/26833482/
  11. Hirten RP, Shah S, Sachar DB, Colombel JF. The Management of Intestinal Penetrating Crohn’s Disease. Inflamm Bowel Dis. 2018; 24: 752-765. PubMed: https://pubmed.ncbi.nlm.nih.gov/29528400/
  12. Feagins LA, Holubar SD, Kane SV, Spechler SJ. Current strategies in the management of intra-abdominal abscesses in Crohn’s disease. Clin Gastroenterol Hepatol. 2011; 9: 842-850. PubMed: https://pubmed.ncbi.nlm.nih.gov/21679776/
  13. Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2017; 11: 135-149. PubMed: https://pubmed.ncbi.nlm.nih.gov/27660342/
  14. de Barros KSC, Flores C, Harlacher L, Francesconi CFM. Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery. Dig Dis Sci. 2017; 62: 2481-2488. PubMed: https://pubmed.ncbi.nlm.nih.gov/28748409/
  15. Bemelman WA, Warusavitarne J, Sampietro GMM, et al. ECCO-ESCP Consensus on Surgery for Crohn’s Disease. J Crohns Colitis. 2018; 12: 1-16. PubMed: https://pubmed.ncbi.nlm.nih.gov/28498901/
  16. Gervais DA, Hahn PF, O’Neill MJ, Mueller PR. Percutaneous abscess drainage in Crohn’s disease: technical success and short-term and long-term outcomes during 14 years. Radiology 2002; 222:645-651. PubMed: https://pubmed.ncbi.nlm.nih.gov/11867780/
  17. Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg. 2002; 137: 845-849. PubMed: https://pubmed.ncbi.nlm.nih.gov/12093344/
  18. Ballard DH, Erickson AEM, Ahuja C, Vea R, Sangster GP, D’Agostino HB. Percutaneous management of enterocutaneous fistulae and abscess-fistula complexes. Dig Dis Interv. 2018; 2: 131-140. PubMed: https://pubmed.ncbi.nlm.nih.gov/31073548/
  19. Lobatón T, Guardiola J, Rodriguez-Moranta F, Millán-Scheiding M et al. Comparison of the long-term outcome of two therapeutic strategies for the management of abdominal abscess complicating Crohn’s disease: percutaneous drainage or immediate surgical treatment. Colorectal Dis. 2013; 15: 1267-1272.
  20. Akinci D, Ergun O, Topel Ç, Çiftçi T, Akhan O. Pelvic abscess drainage: outcome with factors affecting the clinical success. Diagn Interv Radiol. 2018; 24: 146-152. PubMed: https://pubmed.ncbi.nlm.nih.gov/29770767/
  21. Dariushnia SR, Mitchell JW, Chaudry G, Hogan MJ. Society of Interventional Radiology Quality Improvement Standards for Image-Guided Percutaneous Drainage and Aspiration of Abscesses and Fluid Collections. J Vasc Interv Radiol. 2020; 31: 662-666.e4. PubMed: https://pubmed.ncbi.nlm.nih.gov/32061521/
  22. Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012; 23: 727-736. PubMed: https://pubmed.ncbi.nlm.nih.gov/22513394/
  23. Harisinghani MG, Gervais DA, Hahn PF, Cho CH, Jhaveri K, et al. CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome. Radiographics. 2002; 22: 1353-1367. PubMed: https://pubmed.ncbi.nlm.nih.gov/12432107/
  24. He X, Lin X, Lian L, Huang J, Yao Q, et al. Preoperative Percutaneous Drainage of Spontaneous Intra-Abdominal Abscess in Patients With Crohn’s Disease: A Meta-Analysis. J Clin Gastroenterol. 2015; 49: e82-e90. PubMed: https://pubmed.ncbi.nlm.nih.gov/25216386/
  25. Lorenz JM, Al-Refaie WB, Cash BD, et al. ACR appropriateness criteria radiologic management of infected fluid collections. J Am Coll Radiol. 2015; 12: 791-799. PubMed: https://pubmed.ncbi.nlm.nih.gov/26145248/
  26. Yamaguchi A, Matsui T, Sakurai T, Ueki T, Nakabayashi S, et al. The clinical characteristics and outcome of intraabdominal abscess in Crohn’s disease. J Gastroenterol. 2004; 39: 441-448. PubMed: https://pubmed.ncbi.nlm.nih.gov/15175942/
  27. Bermejo F, Garrido E, Chaparro M, Gordillo J, Mañosa M, et al. Efficacy of different therapeutic options for spontaneous abdominal abscesses in Crohn’s disease: are antibiotics enough? Inflamm Bowel Dis. 2012; 18: 1509-1514. PubMed: https://pubmed.ncbi.nlm.nih.gov/22674826/
  28. Müller-Wille R, Iesalnieks I, Dornia C, Ott C, Jung EM, et al. Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn’s disease. Int J Colorectal Dis. 2011; 26: 769-774. PubMed: https://pubmed.ncbi.nlm.nih.gov/21286921/
  29. Sahai A, Belair M, Gianfelice D, Coté S, Gratton J, et al. Percutaneous drainage of intra-abdominal abscesses in Crohn’s disease: short and long-term outcome. Am J Gastroenterol, 1997; 92: 275-278. PubMed: https://pubmed.ncbi.nlm.nih.gov/9040205/
  30. Giangreco L, Di Palo S, Castrucci M, Angeli E, Staudacher C. Abdominal abscesses: their treatment and the study of prognostic factors. Minerva Chir. 1997; 52: 369-376. PubMed: https://pubmed.ncbi.nlm.nih.gov/9265119/
  31. Lambiase RE, Deyoe L, Cronan JJ, Dorfman GS. Percutaneous drainage of 335 consecutive abscesses.results of primary drainage with 1-year follow-up. Radiology. 1992; 184: 167-179. PubMed: https://pubmed.ncbi.nlm.nih.gov/1376932/
  32. Van Sonnenberg E, Wittich GR, Goodacre BW, et al. Percutaneous abscess drainage: update. World J Surg 2001; 25: 362-369. PubMed: https://pubmed.ncbi.nlm.nih.gov/11343195/
  33. Van Sonnenberg E, D’Agostino HB, Casola G et al. Percutaneous abscess drainage: current concepts. Radiology 1991; 181: 617-626. PubMed: https://pubmed.ncbi.nlm.nih.gov/1947068/
  34. Jaques P, Mauro M, Safrit H, Yankaskas B, Piggott B. CT features of intra-abdominal abscesses: prediction of successful percutaneous drainage. AJR Am J Roentgenol. 1986; 146: 1041-1045. PubMed: https://pubmed.ncbi.nlm.nih.gov/2421562/
  35. Gervais DA, Ho CH, O’Neill MJ, Arellano RS, Hahn PF, et al. Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. AJR Am J Roentgenol. 2004; 182: 463-466. PubMed: https://pubmed.ncbi.nlm.nih.gov/14736682/
  36. Yaari S, Benson A, Aviran E, Lev Cohain N, Oren R, Sosna J, et al. Factors associated with surgery in patients with intra-abdominal fistulizing Crohn’s disease. World J Gastroenterol. 2016; 22: 10380-10387. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175250/
  37. Mueller PR, vanSonnenberg E, Ferrucci JT Jr. Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part II. Current procedural concepts. Radiology. 1984; 151: 343-347. PubMed: https://pubmed.ncbi.nlm.nih.gov/6709903/