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P661 Abscess and fistula in Crohn’s disease

K. Sahnan*1, A. Askari1, S. Adegbola1, P. Tozer1, R. Phillips1, A. Hart2, O. Faiz1

1St Mark’s Hospital, Colorectal Surgery, London, United Kingdom, 2St Mark’s Hospital, IBD/Physiology, London, United Kingdom

Background

Anorectal sepsis accounts for both abscess and fistula and contributes a significant caseload in general surgical departments. Patients with Crohn’s disease (CD) not only have an increased risk of anorectal sepsis but also often have a more aggressive disease pattern. As such, early diagnosis and identification is key in these patients.

Methods

The Hospital Episode Statistics (HES) dataset from April 1997 to March 2012 was analysed. First presentations with abscess and subsequent fistula formation were identified and compared with the diagnosis of Crohn’s disease.

Results

In total, 165 176 patients presented with an abscess (first admission) from April 1997– 2012. Complete data were available for 159 052, resulting in a 96.0% capture, and which went onto to further analysis. Crohn’s disease was found in 4.8% of our study population (n = 7 708). The overall rate of fistula formation of 47% from preceding abscess. Of those who did proceed to fistula, 84% did so within the first 12 months. CD diagnosis was known in 42.2% of the patients presenting with abscess. The remainder were diagnosed at the time of their admission (16.5%) or after (41.2%; with a median time to diagnosis of 14 months; IQR 4–40). Of the patient who were diagnosed after the abscess presentation, 53% were subsequently admitted with a fistula. Of these patients, a proportion were diagnosed in the interim between having an abscess and fistula (28.1%), during the fistula episode (16.2%), or after the episode (55.7%), with a median time to diagnosis of 5 months (IQR 2–10). Further, 2.8% of all abscesses in our study (n = 4 454) went onto a diagnosis of Crohn’s disease after the initial presentation with an abscess.

Figure 1. Crohn’s cohort and the timing of the diagnosis.

Conclusion

This is 1 of the largest studies looking at Crohn’s abscesses. It highlights a key clinical concern that 3 out of 100 patients with abscesses seen in an emergency surgical department will have or develop Crohn’s disease.