Percutaneous drainage is the preferred treatment for intra-abdominal abscesses in patients with Crohn disease. An open or laparoscopic peritoneal lavage is performed only if percutaneous drainage is not feasible or fails to control the sepsis, or if a macroscopic bowel perforation is seen by imaging studies. In contemporary practice, Crohn-related abscesses can be managed with this method.
Surgery is indicated in patients with medically refractory disease, perforation, intractable hemorrhage, persisting or recurrent obstruction, abscess, dysplasia, or cancer. The most common reason for surgical bowel resection in Crohn disease is small bowel obstruction caused by a fibrostenotic stricture. Another reason for resection is related to penetrating disease (ie, an abscess or phlegmon caused by internal fistula or sinus tract).
Although an intestinal resection is the most definitive treatment for a stricture, a strictureplasty may be performed as bowel-preserving approach in patients at risk for short gut syndrome.
Learn more about surgical intervention in Crohn disease.
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Cite this: Jaime Shalkow, Cristian Puerta. Fast Five Quiz: Management of Crohn Disease - Medscape - Jan 12, 2022.