Financial disclosures: A.C.M.: UCB (advisory board), Schering-Plough (honorarium), Abbott (honorarium); A.S.C.: UCB (advisory board), Abbott (advisory board).
Abdominal phlegmons in Crohn's disease: Outcomes following antitumor necrosis factor therapy†
Article first published online: 6 JUN 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 4, pages 691–696, April 2012
How to Cite
Cullen, G., Vaughn, B., Ahmed, A., Peppercorn, M. A., Smith, M. P., Moss, A. C. and Cheifetz, A. S. (2012), Abdominal phlegmons in Crohn's disease: Outcomes following antitumor necrosis factor therapy. Inflamm Bowel Dis, 18: 691–696. doi: 10.1002/ibd.21783
- Issue published online: 19 MAR 2012
- Article first published online: 6 JUN 2011
- Manuscript Accepted: 29 APR 2011
- Manuscript Received: 8 APR 2011
- Crohn's disease;
- anti-tumor necrosis factor, infliximab
An abdominal phlegmon is an inflammatory mass that can develop in the setting of penetrating Crohn's disease (CD). Anti-tumor necrosis factor (TNF) antibody therapy is typically avoided in CD complicated by phlegmon because of concern for peritoneal infection but may offer an effective alternative to surgical resection after infection has been controlled with antibiotics. The aim of this study was to examine outcomes for patients with CD who developed an abdominal phlegmon that was subsequently treated with an anti-TNF antibody.
We retrospectively reviewed the records of all CD patients attending Beth Israel Deaconess Medical Center between 2004 and 2010 with an abdominal phlegmon who were treated with an anti-TNF antibody in order to evaluate the safety and efficacy of this treatment regimen.
There were 13 patients with CD complicated by a phlegmon treated with antibiotics and an anti-TNF antibody at our center between 2004 and 2010. Ten were male. Median time (interquartile range) from diagnosis to development of the phlegmon was 5.9 (1.9–22.7) years. The phlegmon was associated with an abscess in 12 patients. In addition to anti-TNF therapy, all patients were treated with broad-spectrum antibiotics. Anti-TNF therapy was effective without complications in all subjects. Two patients eventually had surgery more than a year after initiating anti-TNF treatment.
Penetrating CD complicated by phlegmon formation may be safely and effectively managed with a combination of antibiotics and anti-TNF therapy. Larger, prospective trials are required to confirm these initial findings. (Inflamm Bowel Dis 2011;)