Medical versus surgical management of penetrating Crohn's disease: the current situation and future perspectives.
The development of penetrating Crohn's disease (CD) occurs in up to 50% of patients over the course of their lifetime. While the presentation of these complications, including free perforation, intra-abdominal abscess, and enteric fistula, are usually obvious, the management can require a nuanced approach, with distinct short and long-term approaches. Areas covered: This review discusses medical and surgical methods of treating these complications, including the role of percutaneous drainage of abscesses, the implications of a stricture associated with a fistula, and the efficacy of postoperative anti-TNF therapy in preventing recurrence after surgical treatment. Expert commentary: An approach to the management of these complications that begins with control of sepsis, including broad-spectrum antibiotics, bowel rest, and nutritional support is proposed. The next appropriate step is a diagnostic evaluation to determine the utility of medical versus surgical therapy, considering the presence of a stricture and prior immunosuppressive therapy. Postoperative anti-TNF therapy, a highly effective method to prevent recurrence, should be considered in many cases.
['Patil|Seema A|SA|', 'Cross|Raymond K|RK|']
D018784:Abdominal Abscess D000465:Algorithms D003424:Crohn Disease D005765:Gastrointestinal Agents D006801:Humans D007412:Intestinal Fistula D007416:Intestinal Perforation D014409:Tumor Necrosis Factor-alpha
complications fistula Abdominal abscess Crohn’s disease and infliximab biological therapies