TREATMENT WITH SUMP DRAINAGE IN PERCUTANEOUS DRAINAGE FAILURE IN ABSCESS DUE TO CROHN'S DISEASE

Male, 24 years old, referred to a tertiary hospital due to sudden-onset abdominal pain lasting 24 hours, associated with fever, nausea, and vomiting. He has a history of Crohn's Disease (CD) for 3 years and irregular use of corticosteroids (CS). Abdominal CT scan upon admission suspected a perforation of the distal ileum blocked by active CD. Empirical antibiotic therapy (ABT) and hydrocortisone were started. After 4 days, there was clinical deterioration, and a follow-up CT showed a large collection in the right lower abdomen, prompting percutaneous drainage. After 25 days, the patient required re-admission due to an enterocutaneous fistula (ECF), obstruction of the previous percutaneous catheter, and intra-abdominal abscess. A laparotomy was performed, revealing a monobloc abdomen and placement of a three-way artisan sump drain. The patient was maintained with an irrigation system, vacuum aspiration, and tubular drainage through the drain, with ECF management. After clinical improvement during hospitalization, infliximab induction (5 mg/kg) was started, and the patient was discharged after 10 days, with the drain removed 22 days post-surgery. Follow-up was arranged with low-output ECF management and infliximab maintenance therapy. CD is a chronic inflammatory disorder that may require surgical treatment in up to 50% of cases. Resection of the affected intestine in CD may improve symptoms but does not cure the disease, as recurrence is common even after resection. In stable patients with blocked perforation and active CD, clinical treatment with ABT and CS is an option to preserve the affected segment. Percutaneous drainage is a minimally invasive treatment alternative for intra-abdominal abscesses. ECF development in CD is a possibility in transmural involvement, especially when associated with stenosis. Immunobiological treatments play a key role in disease control and ECF resolution. Given the impossibility of resection due to the monobloc abdomen, creating a drainage system to cleanse the cavity and manage the ECF with a sump drain increases the chances of local resolution, especially when intestinal resection in CD is contraindicated. In surgical treatment of CD complications, the resection of the smallest amount of intestine necessary for disease control is recommended. Therefore, the use of a sump drain in malnourished patients with active infection, combined with immunobiological therapy, enhances the likelihood of successful disease remission.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025