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P270. Contrast enhanced ultrasound as a valuable tool in complicated Crohn's disease patients

E. Calabrese1, F. Zorzi1, E. Stasi1, E. Lolli1, L. Biancone1, F. Pallone1, 1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy

Background

Crohn's disease (CD) is associated with penetrating complications such as phlegmons and intra-abdominal abscesses. As the management of the patients is influenced by the presence and characterization of such complications, a readily available tool for the diagnosis of extramural complications in CD is needed. Ultrasonography has a good diagnostic accuracy and can be used as the first-line imaging technique in complicated CD patients. Preliminary findings suggest that the assessment of vascularity within intra-abdominal masses may distinguish between phlegmons and abscesses. Aim of our study was to evaluate the possible use of contrast enhanced ultrasound (CEUS) to distinguish between phlegmons and intra-abdominal abscesses in CD patients.

Methods

From November 2011, consecutive patients with CD underwent CEUS. Indications of patient evaluations were symptoms, signs and biochemical exams indicating penetrating behaviour (abdominal pain, mass, fever, elevated CRP and leukocytosis). A total of 16 CD pts (10 M; median age 27 yrs, range 21–54; disease duration: median 48 mos, range 6–360; CD site: ileal in 9 pts, ileo-colonic in 7 pts; CD behavior: penetrating in 15 pts, stricturing in 1 pt; previous ileocolonic resection in 6 pts) were included. Clinical evaluations by an IBD expert and other cross sectional imaging techniques (MR and CT) were considered as gold standard.

Results

CEUS detected abscesses in 6 pts and phlegmons in 10 pts. Four out of 6 abscesses were confirmed by CT-Enteroclysis and these pts underwent surgery during the follow up. The remaining 2 pts with abscesses were treated with antibiotic therapy and are still in follow up (10 mos). In the group of patients with phlegmons, 4 out of 10 patients were evaluated by CT or MRI that confirmed phlegmons in 3 cases but in one patient a deep abscess was identified and this patient subsequently underwent surgery. Six out of 10 pts were clinically followed up (median: 6 mos). Two patients developed an abscess after one week from CEUS despite medical treatment. Overall CEUS correctly identified 13 out of 16 lesions on the basis of cross sectional imaging modalities and clinical follow up used as final diagnosis.

Conclusion

Our preliminary results indicate that CEUS is a non-invasive, radiation free and easily available imaging modality able to differentiate phlegmons from abscesses driving a prompt clinical management in CD patients.