HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) All Versions of this Article: 2223010554v1 222/3/645    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gervais, D. A. Articles by Mueller, P. R. Search for Related Content PubMed PubMed Citation Articles by Gervais, D. A. Articles by Mueller, P. R.

Percutaneous Abscess Drainage in Crohn Disease: Technical Success and Short- and Long-term Outcomes during 14 Years¹

¹ From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114. From the 1999 RSNA scientific assembly. Received March 5, 2001; revision requested April 2; final revision received October 3; accepted October 22. Address correspondence to D.A.G. (e-mail: dgervais@partners.org).

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
PURPOSE: To determine technical success with percutaneous abscess drainage (PAD) in patients with Crohn disease during 14 years.

MATERIALS AND METHODS: Medical records of 32 patients with Crohn disease who underwent PAD from 1985 to 1999 were reviewed. Results of abscess drainage and nature of subsequent surgical procedures were recorded. Factors assessed included postoperative or spontaneous nature of the abscess, documentation of a proved fistula, history of occurrence of prior abscesses, duration of Crohn disease, and use of steroid treatment. Technical success was defined as complete abscess drainage. Short-term success was defined as avoidance of surgery within 60 days of drainage. Long-term success was defined as avoidance of surgery beyond the initial 60-day period. Short-term avoidance of surgery was assessed as a predictor of the need for surgery in the long term. Statistical analysis was performed with the ² test to evaluate predictors of short-term success and to assess short-term success as a predictor of long-term success.

RESULTS: The technical success rate was 96%. In 16 (50%) of 32 patients, the need for surgery in the short term was avoided, and surgery was more likely to be avoided in patients with postoperative abscesses than in those with spontaneous abscesses (P = .07). At long-term follow-up, short-term avoidance of surgery did not significantly increase the likelihood of need for surgery in the long term, which occurred in nine of 16 short-term successes versus five of 15 short-term failures (P = .55). Recurrent abscesses occurred in seven (22%) patients, a rate comparable to that with surgical abscess drainage; four (44%) of nine cases of redrainage were successful.

CONCLUSION: PAD has a high technical success rate of 96%. Half of patients may avoid surgery in the short term.

© RSNA, 2002

Index terms: Abscess, percutaneous drainage, 791.21 • Crohn disease, 75.262 • Interventional procedures, 791.1263

	INTRODUCTION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Abdominal or pelvic abscesses occur in 10%–28% of patients with Crohn disease during their lifetimes (1–5). Abscesses form when transmural bowel inflammation results in fistulization and contained perforation. Several articles about percutaneous abscess drainage (PAD) suggest that in the setting of underlying Crohn disease, the success rate of PAD may be less than the PAD success rates of 84%–91% for abdominal and pelvic abscesses in patients who do not have Crohn disease (6–14). However, many of the articles about PAD in the setting of Crohn disease describe technical success and short-term results with respect to the need for subsequent surgery (6–12). Few provide a longitudinal tracking of individual patients or include assessment of the role of PAD as one of many invasive interventions a patient may need throughout years of living with Crohn disease (13).

The purpose of our study was to determine technical success with PAD in patients with Crohn disease during 14 years.

	MATERIALS AND METHODS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
All patients with Crohn disease who underwent percutaneous abdominal or pelvic abscess drainage during 14 years from July 1985 through July 1999 were identified by means of an electronic search of a hospital database and an interventional radiology database. A minimum of 22 months of long-term follow-up was available for surviving patients at the time this study was completed. Medical records of all patients were reviewed (D.A.G.) with the permission of the institutional human research committee. Permission from patients was not required and was not obtained. All relevant Crohn disease–related procedures prior and subsequent to abscess drainage were recorded. Duration of diagnosis of Crohn disease, history of prior abscesses, and abscess location were also noted. The use of steroid treatment in Crohn disease at the time just prior to diagnosis of the abscess was recorded. Documentation of a fistula with imaging, size of the abscess, initial volume of drainage, duration of drainage, and subsequent catheter manipulations were also noted. Complications of PAD were recorded.

Our study population included 32 patients (18 males, 14 females; mean age, 35 years; age range, 4–73 years).

Drainage and Catheter Management
Abscess drainage was performed by using standard imaging-guided techniques (14,15). Fifty-seven catheters were placed overall either with the trocar technique tandem to a guiding needle (n = 52) or with the Seldinger technique (n = 5) at the discretion of the attending radiologist who was evaluating the case. All cases were evaluated by both a fellow-in-training and a staff attending radiologist.

Catheters were placed with ultrasonographic (n = 15) or computed tomographic (CT) (n = 38) guidance or with fluoroscopic guidance for wire manipulation following initial needle placement with CT guidance (n = 4). Catheter size and number of catheters were determined by the attending interventional radiologist who was performing the abscess drainage on the basis of the nature of the fluid obtained at needle aspiration and the extent of the abscess. Catheter size ranged from 8 to 16 F, with 42 (74%) catheters being 12 F or larger. Catheters were managed by the interventional radiology service in conjunction with the referring service and were flushed with 0.9% sterile saline to maintain patency. Catheter manipulation, if necessary, was considered part of the management of drainage catheters and not a complication or failure. Catheters were removed when drainage diminished to less than 10–20 mL/d. In patients with persistent high outputs (>50 mL/d), injection of contrast material through a catheter, a contrast material–enhanced study of the small bowel, or an enema examination with contrast material was performed to assess the presence and location of a fistula to the bowel.

Definitions of Technical Success and Short- and Long-term Success
Technical success was defined with respect to adequacy of drainage of the target abscess after successful catheter placement. For patients who did not undergo surgery, this definition was based on CT findings that confirmed complete abscess drainage and clinical improvement, which allowed catheter removal. Some patients underwent surgery for bowel resection. For these patients who underwent surgery, technical success was defined on the basis of no residual pus in the percutaneously drained cavity at surgery, with no need for further surgical drainage of the index abscess. Recurrent abscess following complete abscess drainage and catheter removal was not considered a technical failure but was recorded and evaluated separately.

Short- and long-term successes both were defined with respect to the need for surgery for active Crohn disease or complications of Crohn disease following PAD. These terms are thus defined by patient rather than by abscess. A short-term success was defined as a patient who did not undergo Crohn disease–related surgery within 60 days of PAD. A short-term failure was defined as a patient who required Crohn disease–related surgery within 60 days. A long-term success was defined as a patient who did not require Crohn disease–related surgery beyond 60 days after PAD. A long-term failure was defined as a patient who underwent surgery beyond 60 days after PAD. Ostomy reversals were excluded from the analysis because they do not reflect active disease and are not complications of disease.

Patients were categorized on the basis of the nature of the underlying abscess. Spontaneous abscesses were those that arose in the setting of Crohn disease in patients who did not have a history of surgery in the preceding 30 days. Postoperative abscesses were those diagnosed within 30 days of Crohn disease–related surgery. Patients were also evaluated for location, size, and number of abscesses at presentation for initial drainage. Finally, abscesses were categorized as initial versus recurrent abscesses. A recurrent abscess was defined as an abscess that occurred in the same location as a previously drained abscess after resolution of the initial abscess. Recurrent abscesses were evaluated separately to determine whether the results for drainage of recurrences differed from the results for drainage of initial abscesses. If a patient developed an abscess in a different location from a previously drained abscess, it was deemed a new abscess rather than a recurrence. The incidence of development of new abscesses was assessed separately for those developing in the short term (within 60 days of percutaneous drainage) and in the long term (beyond 60 days after percutaneous drainage).

Statistical Analysis
The ² test was used for the following variables as a predictor of short-term success in a univariate analysis: sex of the patient, underlying nature (spontaneous or postoperative) of the abscess, documentation with imaging of a fistula from the bowel to the abscess, new or old diagnosis of Crohn disease at presentation for initial abscess drainage, history of prior abscess, use of steroid treatment for underlying Crohn disease at and just prior to the time of diagnosis of the abscess, and number and location of abscesses at initial presentation for drainage. Likewise, short-term success was assessed as a predictor of long-term failure. The t test was used to assess for differences between group means. P values less than or equal to .05 were considered statistically significant.

	RESULTS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Abscess Drainage and Technical Success
Abscess size was 2–10 cm in maximal transverse diameter, and initial volume removed at drainage was 10–2,000 mL. In four abscesses, two catheters were placed at presentation. Nineteen patients presented only once for drainage of a single abscess, and three patients had multiple abscesses at multiple presentations. The remaining 10 patients underwent drainage multiple times for recurrent and/or new abscesses.

Thirty (94%) of 32 patients with 51 (96%) of 53 abscesses were technical successes. Of the two patients who required additional surgical drainage of the index cavity, in one patient a catheter was placed in an incompletely drained abscess, and then the patient underwent ileocolectomy with primary anastomosis. The other patient underwent multiple surgical and interventional radiologic procedures during a prolonged hospitalization owing to transverse colon perforation, for which she underwent colectomy with colostomy formation. She ultimately underwent placement of three percutaneous catheters, but her condition continued to deteriorate and she required drainage of the residual abscess, fistula repair, and multisegmental bowel resection 34 days after the initial drainage.

Five abscesses required catheter manipulation (repositioning, upsizing, or replacement with a catheter of the same size) to optimize drainage. Two catheters had backed nearly out of the abscess. One catheter was believed to be in a suboptimal position. One catheter was thought to be too small on the basis of the finding of a residual abscess at imaging, and one catheter had kinked, which resulted in clogging of the catheter and leakage around it.

Abscess locations are delineated in Table 1. The most common abscess location was the right lower quadrant (n = 16) of the abdomen, followed by the left lower quadrant (n = 10) and the psoas muscle (n = 10). Abscesses occurred in the left and right upper quadrants, midabdomen, and deep pelvis less frequently, by approximately 50% or less, compared with occurrence in the three most frequent locations. There was one perineal abscess. Because of the small number of technical failures, we were unable to ascertain statistically whether abscess location was a significant predictor of adequate PAD. Most abscesses were adequately drained percutaneously regardless of location.

Patients with a history of a prior Crohn disease–related abscess appeared more likely to be short-term successes compared with patients presenting with their first abscess. Seven of eight patients with a history of abscess had short-term successes, and nine of 24 patients presenting with their first abscess had short-term successes (P = .05).

Sex, duration of disease, and need for steroid treatment at the time of diagnosis of abscess were not statistically significant predictors of short-term success or failure. Half each of males and females and half each of patients with new and old disease had short-term successes. Nineteen patients were receiving steroid treatment at the time of diagnosis of abscess, and 13 were not. Eight (42%) of 19 patients who were receiving steroid treatment had short-term successes compared with eight (62%) of 13 patients who were not receiving steroid treatment. Thus, there was a trend for patients not receiving steroid treatment to be more likely to have short-term successes, but this trend did not reach statistical significance (P = .28).

Long-term Results
Thirty-one patients were followed up for long-term analysis after one patient died in the short term. Mean length of follow-up was 7.2 years (range, 1.8–15.3 years). Two other patients died during the longitudinal course of this study; one died at 19 months of follow-up owing to gastrointestinal bleeding and the other died at 70 months of follow-up owing to cancer. In the long term beyond 60 days, nine (56%) of 16 patients in the short-term success group required Crohn disease–related surgery, and five (33%) of 15 patients in the short-term failure group required Crohn disease–related surgery. Short-term success was not a significant predictor of the need for surgery in the long term (P = .55). Overall, seven (23%) of 31 patients avoided surgery in both long and short terms. Among these were three patients with spontaneous and four with postoperative abscesses. The overall distribution of patients according to long- and short-term results is summarized in the Figure.

View larger version (27K): [in this window] [in a new window] [Download PPT slide]   Results of PAD in patients with Crohn disease with respect to the need for surgery during both short and long terms.

Of the 11 patients with recurrent abscesses, two patients underwent surgical abscess drainage. One patient underwent surgery at the discretion of the surgeon who chose not to refer the patient for repeat percutaneous drainage. The other patient could not undergo percutaneous drainage because of the absence of a safe percutaneous access path. The remaining nine patients underwent redrainage of recurrent abscess. Of these nine patients, five (56%) subsequently required surgery within 60 days and four (44%) required no surgery within 60 days. Of the five short-term failures after redrainage, four patients had spontaneous abscesses, one had a postoperative abscess, and three had a documented fistula. Of the short-term successes after redrainage, two patients had spontaneous abscesses, two had postoperative abscesses, and none had documented fistulas. While these overall short-term results for redrainage parallel those for initial drainage, with patients with spontaneous abscesses tending to be more likely to require surgery, these small numbers preclude meaningful statistical analysis.

In the long term, or greater than 60 days, the four patients who successfully underwent redrainage in the short term were also long-term successes, and they required no further Crohn disease–related surgery; the mean time to follow-up was 6.9 years (range, 0.8–11.7 years). Of the five short-term redrainage failures, three required no further surgery beyond 60 days and two required additional surgery beyond 60 days. Finally, both patients who underwent surgical drainage of a recurrent abscess were long-term failures.

New Abscesses
Five (16%) of 32 patients whose index abscesses were successfully percutaneously drained developed new abscesses within 60 days of percutaneous drainage. Four of these five additional abscesses were drained at surgery and one was drained percutaneously. The patient whose abscess was drained percutaneously required no further short- or long-term procedures. Two (6%) of 32 patients developed one new abscess each beyond the initial 60-day period at 10 months and 12.5 years following initial drainage. Both abscesses were drained percutaneously without the need for additional surgery in the short or long term.

Complications
One patient developed an enterocutaneous fistula at the site of percutaneous catheter placement following successful resolution of the abscess cavity. The fistula was repaired at surgery. There were no hemorrhagic complications, bowel injuries, or other organ injuries.

	DISCUSSION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 
Crohn disease is a chronic condition that often requires multiple surgical procedures during a patient’s lifetime. Approximately 70%–90% of patients with Crohn disease require surgery, and 33%–82% undergo a second operation during the course of the disease (16). Up to 33% may require more than two bowel resections (16). The results of PAD must be viewed within this context, with the goal of minimizing invasiveness of interventions equally as important as minimizing the number of interventions. The literature contains several articles, all retrospective and predominantly with smaller series of patients, about PAD in the setting of Crohn disease (6–12). To the best of our knowledge, only one other article in the medical literature provides analysis of success with respect to both the short- and long-term need for Crohn disease–related surgery (13). Our series is the largest in terms of both number of abscesses and number of patients to undergo percutaneous drainage and provides the longest longitudinal follow-up of individual patients. Despite the limitations of retrospective analysis, the size of our series allows several observations, and findings of this study further confirm the utility of PAD in Crohn disease.

Our results are similar to those of Sahai et al (13) with respect to their overall short-term success rate (56%), long-term outcomes, and significance of a documented fistula with respect to the need for surgery in the short term. With respect to spontaneous versus postoperative abscesses, Sahai et al (13) also observed a trend of postoperative abscesses more likely to be short-term successes than spontaneous abscesses, with a P value of .091. Other investigators did not assess long-term results in the same fashion, but analysis of their series shows similar trends emerging with respect to short-term success for spontaneous versus postoperative abscesses. Safrit et al (7) successfully drained two of two postoperative abscesses but only five of 16 spontaneous abscesses. Casola et al (6) drained four of four postoperative abscesses compared with eight of 11 spontaneous abscesses.

This trend toward better outcomes with postoperative abscesses as documented by prior investigators is confirmed by findings in our study. These results could be explained by the fact that the diseased segment is left in situ in the setting of PAD for spontaneous abscesses. Therefore, unless medical treatment substantially mitigates disease activity, the conditions that led to abscess formation remain, and the abscess could easily recur. In postoperative abscesses, the diseased segment or segments of bowel have presumably been removed. An abscess may form from a localized intraoperative contaminated site or anastomotic leak. Without persistent bowel inflammation or persistent leak, this abscess would be expected to resolve with PAD and administration of antibiotics.

Other investigators (6–13) have reported PAD success rates of 25%–80% with respect to the need for subsequent surgery as well as PAD technical success rates of 53%–100%. One possible explanation for the difference between our experience and the experiences of other investigators may be geographic variations in the available interventional radiologic technical skill as well as variations in surgical practice patterns with respect to treatment of Crohn disease. In an article by Jawhari et al (11), seven of 15 patients had abscesses that were inaccessible to percutaneous drainage; this number seems unusually high in our experience, and Jawhari et al attributed the low utilization of PAD in their series to a high dependence on "patterns of management." A highly skilled team of interventional radiologists is crucial to affording patients the benefits of PAD. Sahai et al (13) noted a difference in interventional skill and surgical "attitude" in their study in which they reported findings of work performed at two different centers, with a corresponding difference in results.

Though we focused our discussion of success on a definition centering on the need for surgery, the high technical success rate of 96% adequacy of abscess drainage is no less important a determinant of the role for PAD in Crohn disease both for patients who undergo surgery and for those who do not undergo surgery in the short term. In all but two patients who underwent subsequent surgery, with PAD the abscess was completely drained, which resulted in a cleaner surgical field and possibly in a less complicated procedure and postoperative course. Casola et al (6) advocated this approach of PAD followed by later bowel resection as opposed to the two-stage surgical approach, which surgeons have used for some patients too ill to undergo immediate definitive surgery. In this approach, surgical abscess drainage is performed first, followed by resection of diseased bowel at surgery later. However, PAD is less invasive than surgical drainage and has a lower rate of enterocutaneous fistula (1,2,4,7). Thus, PAD provides a less morbid approach to abscess treatment, even for patients who ultimately undergo bowel resection.

Fistula formation, as shown by Sahai et al (13), was a significant predictor of the need for surgery. Only two of 10 patients with documented fistulas avoided surgery. These fistulas closed on their own by using treatment with bowel rest, parenteral nutrition, and PAD. Our analysis is limited by the lack of catheter injection in 12 patients who were classified as having no documentation of a fistula. These limited data may account for the differences between our results and those of Casola et al (6) who reported four short-term successes in seven patients with fistulas and suggested that leaving the drainage catheter in for longer periods, with bowel rest and parenteral nutrition, would ultimately allow the bowel to heal without surgical treatment in most cases. We did not find this to occur despite the longer catheter drainage periods in patients with documented fistulas. Since abscess formation in Crohn disease is thought to be caused by perforation and fistulization to a contained abscess cavity, all spontaneous abscesses, with this definition, start with a fistula to the bowel (17). Only those fistulas that persist or are large enough will be detected with imaging and will be included in published articles. Further study is necessary to help predict which fistulas might close and which might not.

Patients who avoided surgery in the short term were not significantly more likely to require surgery in the long term. This suggests that PAD is not simply helping to defer surgery. For seven (22%) of 32 patients who avoided surgery entirely, PAD was not simply a temporizing measure but possibly helped to avoid surgery altogether. Furthermore, despite defining patients who required surgery in the long term as long-term failures for purposes of data analysis, these patients should not be viewed entirely as failures of PAD; instead, these data should be compared with the overall surgical rates for patients with Crohn disease. Our overall rate of 78% of patients undergoing surgery is within the reported surgical results of 70%–90% of patients requiring surgery within their lifetime (16).

No significant difference in PAD short-term outcomes was noted with respect to location or size of abscess, sex, number of abscesses, and need for steroid treatment. Patients who are receiving steroid treatment presumably have more active disease than those who are not. Although patients who were receiving steroid treatment demonstrated a trend to becoming short-term failures of PAD, this trend was not significant. However, a larger series of patients might prove that steroid treatment is a significant predictor of short-term failure.

The only major complication in our 57 cases of abscess drainage was a single enterocutaneous fistula (2%) at the site of catheter placement. Even when reporting by patient rather than by abscess (one [3%] of 32 patients), the rate is acceptably low and compares very favorably with the 21%–85% rate reported following surgical abscess drainage (1,2,4,7). Given the benefits of PAD and its minimally invasive nature, this rate is acceptable and should not limit PAD in the setting of Crohn disease.

Patients with recurrent and additional abscesses characterized a sizable minority of our patients. The rate of recurrence of 34% is within the range of 12%–38% reported in the literature (5,7,18,19) for both PAD and surgical drainage. Furthermore, surgery did not preclude the need for additional long-term procedures in this subgroup, since all of the patients requiring surgery in the long term also underwent surgery in the short term. In addition, the two patients who underwent surgical drainage of recurrent abscesses both required surgery in the long term. On a more encouraging note, recurrent abscesses appear to be equally likely to undergo successful short-term drainage as are initial abscesses, but the small numbers in our study do not allow statistical analysis. However, on the basis of our experience, we are confident that there is no reason to approach a recurrent abscess differently from an initial abscess, since 44% of our cases of redrainage were both short- and long-term successes.

New abscesses in different locations developed in seven patients, and, in the short term, required surgical intervention in four of five patients. These likely reflected noncontained and/or multifocal perforation, which could be difficult to treat percutaneously. The two new abscesses that developed beyond 60 days, on the other hand, likely reflected recurrent disease in a different location and were short- and long-term successes of PAD. As with our recurrent abscesses, the small numbers limit the analysis of these results, but development of new abscesses in the long term does not appear to seriously limit the success of PAD for these additional abscesses.

In conclusion, findings of this study show that in patients with Crohn disease and abdominal or pelvic abscesses, catheter placement by interventional radiologists is successful in almost all cases in which a safe percutaneous path exists, and technical adequacy of abscess drainage is achieved in 96% of these patients. For some patients, surgery can be avoided both in the short and long term. Patients with recurrent abscesses can be offered PAD, because they are not universally fated for surgery. The rate of surgery following PAD will likely vary according to local practice patterns, but patients can expect an approximately 50% chance of undergoing surgery in the short term following PAD on the basis of findings in our work and findings in the work of others. This study shows that for a retrospective sample of 32 patients with Crohn disease and abscesses, success rates of percutaneous drainage are higher for postoperative abscesses compared with those for spontaneous abscesses.

	ACKNOWLEDGMENTS

 
We thank Elkan Halpern, PhD, for his advice concerning statistical analysis used for this study.

	FOOTNOTES

 
Abbreviation: PAD = percutaneous abscess drainage

Author contributions: Guarantor of integrity of entire study, D.A.G.; study concepts and design, all authors; literature research, D.A.G.; clinical studies, D.A.G., P.F.H., P.R.M.; data acquisition, D.A.G., P.F.H., P.R.M.; data analysis/interpretation, all authors; statistical analysis, D.A.G., P.F.H.; manuscript preparation, D.A.G.; manuscript definition of intellectual content, all authors; manuscript editing and revision/review, D.A.G., P.R.M.; manuscript final version approval, all authors.

	REFERENCES

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION REFERENCES

 

1. Nagler SM, Poticha SM. Intraabdominal abscess in regional enteritis. Am J Surg 1979; 137:350-354.
2. Steinberg DM, Cooke WT, Alexander-Williams J. Abscess and fistulae in Crohn’s disease. Gut 1973; 14:865-869.
3. Edwards H. Crohn’s disease: an inquiry into its nature and consequences. Ann R Coll Surg Engl 1969; 44:121-139.
4. Greenstein AJ, Kark AE, Dreiling DA. Crohn’s disease of the colon. Am J Gastroenterol 1974; 62:419-425.
5. Keighley MRB, Eastwood D, Ambrose NS, Allan RN, Burdon DW. Incidence and microbiology of abdominal and pelvic abscess in Crohn’s disease. Gastroenterology 1982; 83:1271-1275.
6. Casola G, vanSonnenberg E, Neff CC, Saba RM, Withers C, Emarine CW. Abscesses in Crohn disease: percutaneous drainage. Radiology 1987; 163:19-22.
7. Safrit HD, Maura MA, Jaques PF. Percutaneous abscess drainage in Crohn’s disease. AJR Am J Roentgenol 1987; 148:859-862.
8. Lambiase RE, Cronan JJ, Dorfman GS, Paolella LP, Haas RA. Percutaneous drainage of abscesses in patients with Crohn disease. AJR Am J Roentgenol 1988; 150:1043- 1045.
9. Doemeny JM, Burke DR, Meranze SG. Percutaneous drainage of abscesses in patients with Crohn’s disease. Gastrointest Radiol 1988; 13:237-241.
10. Millward SF, Ramsewak W, Fitzsimons P, Frost R, Tam P, Toi A. percutaneous drainage of iliopsoas abscess in Crohn’s disease. Gastrointest Radiol 1986; 11:289-290.
11. Jawhari A, Kamm MA, Ong C, Forbes A, Bartram CI, Hawley PR. Intra-abdominal and pelvic abscess in Crohn’s disease: results of non-invasive and surgical management. Br J Surg 1998; 85:367-371.
12. Ayuk P, Williams N, Scott NA, Nicholson DA, Irving MH. Management of intra-abdominal abscesses in Crohn’s disease. Ann R Coll Surg Engl 1996; 78:5-10.
13. Sahai A, Belair M, Gianfelice D, Cote S, Gratton J, Lahaie R. Percutaneous drainage of intra-abdominal abscess in Crohn’s disease: short and long term outcome. Am J Gastroenterol 1996; 92:275-278.
14. vanSonnenberg E, Mueller PR, Ferrucci JT. Percutaneous drainage of 250 abdominal abscesses and fluid collections. I. results, failures, and complications. Radiology 1984; 151:337-341.
15. Mueller PR, vanSonnenberg E, Ferrucci JT. Percutaneous drainage of 250 abdominal abscesses and fluid collections. II. Current procedural concepts. Radiology 1984; 151:343-347.
16. Krupnick AS, Morris JB. The long-term results of resection and multiple resections in Crohn’s disease. Semin Gastrointest Dis 2000; 11:41-51.
17. Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis. JAMA 1932; 99:1323-1329.
18. Greenstein AJ, Sacher DB, Greenstein RJ, et al. Intraabdominal abscess in Crohn’s ileocolitis. Am J Surg 1982; 143:727-730.
19. Rice MA, Meyer KK. Psoas abscess complication Crohn’s disease. Am J Gastroenterol 1985; 80:970-977.

This article has been cited by other articles:

				F. Rypens, J. Dubois, L. Garel, C. Deslandres, and D. Saint-Vil Percutaneous Drainage of Abdominal Abscesses in Pediatric Crohn's Disease Am. J. Roentgenol., February 1, 2007; 188(2): 579 - 585. [Abstract] [Full Text] [PDF]

				Y. J. Kim, J. K. Han, J. M. Lee, S. H. Kim, K. H. Lee, S. H. Park, S. K. An, J. Y. Lee, and B. I. Choi Percutaneous Drainage of Postoperative Abdominal Abscess with Limited Accessibility: Preexisting Surgical Drains as Alternative Access Route Radiology, May 1, 2006; 239(2): 591 - 598. [Abstract] [Full Text] [PDF]

				S P L Travis, E F Stange, M Lemann, T Oresland, Y Chowers, A Forbes, G D'Haens, G Kitis, A Cortot, C Prantera, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: current management Gut, March 1, 2006; 55(suppl_1): i16 - i35. [Abstract] [Full Text] [PDF]

				I H Mallick, M H Thoufeeq, and T P Rajendran Iliopsoas abscesses Postgrad. Med. J., August 1, 2004; 80(946): 459 - 462. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) All Versions of this Article: 2223010554v1 222/3/645    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gervais, D. A. Articles by Mueller, P. R. Search for Related Content PubMed PubMed Citation Articles by Gervais, D. A. Articles by Mueller, P. R.