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Surgical Abscess Drainage for Crohn’s Disease

Medically Reviewed by Minesh Khatri, MD on June 18, 2022

Abscesses are a common problem if you have Crohn’s disease. They’re painful pockets of pus and bacteria that can form in your stomach, pelvis, or around your anus. You’ll need antibiotics to treat the infection, but your doctor also might want to drain the pus to help the area heal.

If the abscess is easily reached by a needle, your doctor might pierce it and draw out the infected fluid through your skin. This procedure is called percutaneous abscess drainage (PAD). Another way is through open surgery, where the surgeon needs to make a bigger cut into the abscess to extract the pus.

Who Needs It?

About 10% to 30% of people with Crohn’s disease get abscesses. They’re caused by swelling that goes through the wall of your intestines, or microperforations – tiny holes – in your bowels. Symptoms include:

  • Painful bowel movements
  • Belly pain
  • A swollen, tender lump at the edge of your anus
  • Pus coming out of your anus
  • Fever

What’s Percutaneous Abscess Drainage (PAD) vs. Open Surgery?

In the past, the go-to method for drainage has been open surgery. This involves doing a bowel resection, in which the surgeon removes the damaged part of your small intestine and joins the two healthy ends. Too many of these surgeries can lead to short bowel syndrome. This means there’s not enough small intestine left to nourish your body properly.

People with Crohn’s disease are often young, and abscesses can come back. So doctors often choose less invasive ways to treat it when possible, such as antibiotics and/or PAD, at least at first.

While antibiotics might be enough to get rid of a small abscess, PAD can be ideal for large or single abscesses. Surgery might still be needed after drainage. For example, if you have fistulas or multiple abscesses, PAD might not be enough.

A survey showed almost 40% of people who were in the hospital for treatment for abscesses were cured solely with antibiotics. PAD and surgery were done about the same number of times – 29% of cases had PAD and 32% had surgery.

When Is Surgery Needed?

It often comes down to the type of abscess and where it is. Things that may lead to surgery include:

  • The needle can’t reach the abscess to do a PAD.
  • An internal abscess is too big to be drained by needle. This might require a larger cut to remove the pus.
  • PAD didn’t drain all the infected liquid.
  • The abscess is multilocular, meaning it has more than one chamber that needs to be emptied.
  • There are several abscesses.
  • The abscess is for a fistula.

Experts don’t have an estimate of how many people who have PAD will need surgery later, and studies don’t agree, either. Some experts feel if a diseased part of a bowel goes without being cut out, an abscess is likely to happen again in the future. Some people have an elective or planned surgery to try to avoid future complications, or an emergency surgery.

The abscess pain should go away after surgery. You might be a bit sore in the area you were cut. It takes about 3 to 8 weeks for an abscess to completely heal, but you likely can get back to normal life in a day or two.

What Happens During Surgery?

You’ll get anesthesia during the operation. It’s often done using laparoscopy, meaning your surgeon will use tiny instruments to make only very small cuts in the abscessed area. Your surgeon will slip a thin, flexible instrument with a camera and light on the end into one of the cuts. The images from inside your body will show on a video monitor.

Your surgeon will cut out the part of your bowel with the abscess. Usually, there’s enough healthy intestine to join the ends. If there isn’t, you might have an ileostomy. The doctor will make an opening in the area, usually your belly, so your intestines can drain into a bag outside your body.

What’s the Recovery Time From Surgery?

You’ll likely stay in the hospital for 3 days so your health care team can check in on you while your body heals. You’ll get pain meds as needed, and help with your ostomy bag if you have one. If the pouch is temporary, you’ll have another surgery about 2 or more months later to reconnect the healed intestine.

Show Sources

SOURCES:

Crohn’s & Colitis Foundation: “Abscess Drainage,” “Surgery for Crohn’s Disease and Ulcerative Colitis,” “Small and Large Bowel Resection.”

NYU Langone: “Surgery for Inflammatory Bowel Disease in Adults.”

Radiological Society of North America (RSNA): “Abscess Drainage.”

World Journal of Gastrointestinal Endoscopy: “Management of Abdominal and Pelvic Abscess in Crohn’s disease.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts for Crohn’s Disease.”

Medscape: “Crohn Disease Clinical Presentation.”

Infectious Diseases: “Research and Treatment: Medical Versus Interventional Treatment of Intra-Abdominal Abscess in Patients With Crohn’s Disease.”

Journal of Coloproctology: Current Management of Spontaneous Intra-abdominal Abscess in Crohn's Disease.”

MyHealth.Alberta.ca: “Anorectal Abscess Surgery: What to Expect at Home.”

National Health Service (U.K.): “Treatment – Abscess.”

Johns Hopkins Medicine: “Types of Surgery.”

University of Iowa Health Care: “Anorectal Fistula.”

Cleveland Clinic: “Anal Fistula.”

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