Crohn abscess

Crohn s disease may be complicated by intestinal strictures, fistulae and intra-abdominal abscesses. Surgery is often necessary but strictures may be amenable to endoscopic balloon dilatation and abscesses can be drained under radiographic control. 

BenUdjeh, T., Ridwelskl, K., Wolff, H., Gellert, K., Lnnlng, M., Pert-schy, J. Liver abscess as a first manifestation of Crohn s disease. Dig. Surg. 1992 9 288-292... 

Kotanagi, H., Sone, S., Fukuoka, T., Narisawa, T., Koyama, K., Yagi-sawa, H., Chiba, M., Masamune, O. Liver abscess as the initial manifestation of colonic Crohn s disease report of a case. Japan. J. Surg. 1991 21 348 -351... 

Mir-Madjlessi, S.H., McHenry, M.C., Farmer, R.G. Liver abscess in Crohn s disease. Report of four cases and review of the literature. Gastroenterology 1986 91 987-993... 

Tavarela Veloso, F., Araujo Teixeira, A., Saraiva, C., Carvalho, J., Maia, J., Fraga, J. Hepatic abscess in Crohn s disease. Hepato-Gastroenterol. 1990 37 215-216... 

Amoebic liver abscess Aspergillosis Crohn s disease Echinococcosis Hepatic abscess Schistosomiasis Syphilis Tuberculosis... 

An 11-year-old boy with Crohn s disease received infliximab and 3 days later developed fever, signs of cardiac failure, and S. aureus sepsis (52). At surgery an intramyocardial para-aortic abscess with destruction of the aortic valve was found, suggesting chronic infection, possibly activated by the use of infliximab. 

Crohn s disease can lead to vasculitic changes of the aorta, which may have favored the development of the intramyocardial abscess in this case. The size of the abscess suggested persistence for several weeks. 

Common complications of IBD include rectal fissures, fistulas (Crohn s disease), perirectal abscess (ulcerative colitis), and colon cancer, in addition to hepatobiliary complications, arthritis, uveitis, skin lesions (including erythema nodosum and pyoderma gangrenosum), and aphthous ulcerations of the mouth. 

To treat IBD properly, the clinician must have a clear concept of realistic therapeutic goals for each patient. These goals may relate to resolution of acute inflammatory processes, resolution of attendant complications (e.g., fistulas and abscesses), alleviation of systemic manifestations (e.g., arthritis), maintenance of remission from acute inflammation, or surgical palliation or cure. The approach to the therapeutic regimen differs considerably with varying goals as well as with the two diseases, ulcerative colitis and Crohn s disease. 

Surgical procedures have an established place in the treatment of IBD. Although surgery (proctocolectomy) is curative for ulcerative cohtis, this is not the case for Crohn s disease. Surgical procedures involve resection of segments of intestine that are affected, as well as correction of complications (e.g., fismlas) or drainage of abscesses. 

Inflammatory bowel disease Ulcerative colitis Crohn s disease Localization of sepsis Localization of abscesses... 

Antibiotics can be used as either (1) adjunctive treatment along with other medications for active IBD (2) treatment for a specific complication of Crohn s disease or (3) prophylaxis for recurrence in postoperative Crohn s disease. Metronidazole, ciprofloxacin, and clarithromycin are the antibiotics used most frequently. They are more beneficial in Crohn s disease involving the colon than in disease restricted to the Ueum. Specific Crohn s disease-related complications that may benefit from antibiotic therapy include intra-abdominal abscess and inflammatory masses, perianal disease (including fistulas and perirectal abscesses), small bowel bacterial overgrowth secondary to partial small bowel obstruction, secondary infections with organisms such as Clostridium difficile, and postoperative complications. Metronidazole may be particularly effective for the treatment of perianal disease. Postoperatively, a 3-month course of metronidazole (20 mg/kg/day) can prolong the time to both endoscopic and clinical recurrence. 

Crohn disease and peri-appendiceal abscesses should be considered as differential diagnoses, as well as, although less frequently in the case of children, carcinoma and lymphoma. 

Abdominal ultrasound (US), thanks to its accuracy, good repeatability and non-invasiveness is currently employed in many chronic inflammatory conditions, not only for purely diagnostic purposes, but also for management of the disease. In Crohn s disease (CD) patients, US has become the first-line imaging procedure for early diagnosis of the disease (Parente et al. 2004a), and more frequently for the follow-up, to detect intra-abdominal complications (strictures, fistulae and abscesses), to assess activity and monitor the course of disease, as a prognostic index of recurrence (Table 7.1). 

Maconi G, Sampietro GM, Parente F et al (2003b) Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn s disease a prospective comparative study. Am J Gastroenterol 98 1545-1555... 

In the majority of cases, tuboovarian abscesses (TOA) result from pelvic inflammatory disease. It is reported to complicate PID in up to one-third of patients hospitalized for treatment [6]. Other etiologies include complications of surgery or intra-abdominal inflammatory bowel diseases, such as appendicitis, diverticulitis, or Crohn disease. In most cases, TOA is caused by a polymicrobial infection with a high prevalence of anaerobes. lUD users, especially in the first few months after insertion, are also under a higher risk of PID. Pelvic actinomycosis is considered to be highly associated with the use of lUD [1]. 

Ulcerative colitis is a mucosal disease that primarily affects the rectum. It is typically left-sided or diffuse, and only rarely involves the right colon exclusively [64]. The mean wall thickness in Crohn disease is usually greater than in ulcerative colitis [65]. The halo sign, a low-attenuation ring in the bowel wall caused by deposition of submucosal fat, is seen more commonly in ulcerative colitis than in Crohn disease. Proliferation of mesenteric fat is almost exclusively seen in Crohn disease, whereas proliferation of perirectal fat is nonspecific and can result from Crohn disease, ulcerative colitis,pseudomembranous colitis, or radiation colitis [64]. Abscesses are almost exclusively found in Crohn disease and not in ulcerative colitis [62]. 

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