1043 Percutaneous Drainage of Abscesses in Patients with Crohn Disease Robert E. Lambiase1 John J. Cronan Gary S. Dorfman Landy P. Paolella Richard A. Haas Received September 10, 1987; accepted after revision December 29, 1987. 1JI authors: Department of Diagnostic RadiOI- ogy, Rhode Island Hospital. Brown I.kiiverstty Pro- gram in Medicine, 593 Eddy St., Providence, RI 02902. Address reprint requests to A. E. Lambiase, Rhode Island HOStal, Radiology, Special Proce- dures, 593 Eddy St., Providence, RI 02902. AJR 150:1043-1045, May 1988 0361 -803X/88/1 505-1043 C American Roentgen Ray Society Up to one-quarter of patients with Crohn disease present with abdominal abscesses at some point in their illnesses, most of which have enteric communication. The efficacy of percutaneous drainage alone vs either a combined percutaneous/surgical approach or a purely surgical approach has not been established. We reviewed the results of percutaneous drainage of nine abscesses in eight patients with Crohn disease. Six of these abscesses communicated with the intestine. Those with enteric communication had temporary palliation, with improved medical status However, all patients required definitive surgery within 7 weeks of Initial drainage. Percutaneous drainage in the three patients without entenc communication resufted in a permanent cure. Our experience with this small series suggests that abscesses that have an enteric communication in patients with Crohn disease can be temporarily paliiated by percuta- neous drainage. However, use of this technique is unlikely to result in long-term palliation or cure. It appears that abscesses with intestinal communication in Crohn patients can be cured by percutaneous therapy alone. A growing number of clinical series have established the efficacy of percutaneous abscess drainage [1 -3]. Abscesses that communicate with the intestine represent a subpopulation that require the use of special drainage techniques [4-6]. Enteric communication is present in most of Crohn patients who present with abscesses. In these patients, the diseased and perforated segment of bowel, which is the source of the abscess, creates particular problems. We report our results with percutaneous drainage of nine abscesses in patients with Crohn disease, six of which had enteric communication. Subjects and Methods We retrospectively reviewed the medical records and radiographic studies of 176 patients who had percutaneous abscess drainages (not including sterile fluid aspiration) at our institution over the last 3 years. Nine abscesses in eight patients with pathologically docu- mented Crohn disease were included in the series that forms the basis of this study. The age range of the patients was 23-55 years (mean, 36). Four of the patients were men. All were dinically classified as having severe Crohn disease, with multiple previous admissions for acute exacerbations. The duration of documented disease ranged from 8 to 15 years. Only one patient had no previous surgery; two patients had had surgery within the last year. Most had had remote resection of the small bowel and ascending colon at least 5 years earlier. Five of eight had colonic as well as small-bowel involvement. On admission, all had mild to moderate leukocytosis, fever, and either localized or diffuse abdominal tenderness. Five of the patients were on chronic low-dose adrenocorticosteroid therapy, with one patient on high-dose treatment for an acute exacerbation. One patient was also receiving azulfidine. In five of the eight Crohn patients, a single abscess communicated with the gastrointestinal tract. One patient had two abscesses, both of which had an entenc communication. All six communicated to the small bowel, with one also communicating with the colon. One patient also had a cutaneous fistula. The communications were radiographically shown in four patients