Management of disease-related abdominal abscesses in Crohn’s disease

Abstract

Introduction: Crohn’s disease (CD)-related abdominal abscesses require tailored management strategies taking into consideration the variability in abscess size, location, and underlying CD activity. Areas covered: This review discusses current approaches to CD-related abscesses. Literature review was performed through the PubMed and Medline databases to identify studies pertinent to the wide-ranging focus of this review. Expert opinion: Early, individualized treatment combining medical and surgical strategies is crucial for optimizing outcomes in patients with CD-related abdominal abscesses. Antibiotics are effective for smaller abscesses in hemodynamically stable patients; however, recurrence is common, necessitating close monitoring. Percutaneous drainage (PD) provides a less invasive alternative to surgery, offering high initial success rates but variable long-term results, as many patients ultimately need a definitive surgical intervention. For larger or complex abscesses, surgery may be necessary to address both the abscess and underlying CD. Despite its invasiveness, surgery is associated with high success rates and reduced recurrence risk. Biologic therapies, particularly anti-TNF agents, have shown promise in managing CD-associated abscesses, and can reduce abscess recurrence risk without surgery. While biologics may help delay or avoid surgery in select patients, interdisciplinary collaboration is essential to mitigate the risks associated with immunosuppression in the presence of intra-abdominal infections.