Catheters can delay or eliminate surgery for Crohn's disease patients

(HealthDay News) – While more medicines have been found to help fight the pain and discomfort caused by Crohn's disease, some patients will require surgery.

And an operation often can be avoided through the insertion of a catheter, which drains infectious abscesses, scientists have found.

Using the catheter to rid pelvic or abdominal abscesses of accumulated fluid in people with Crohn's disease is highly effective, and can delay or avoid surgery.

Researchers from Massachusetts General Hospital and Harvard Medical School found catheter use on Crohn's patients effective in 2002 and published the findings in the journal Radiology .

This method, called percutaneous abscess drainage (PAD), had a 96 percent success rate and postponed or eliminated the need for surgery in many of the people in the study, the scientists found.

Seven out of 100,000 people have Crohn's disease, a chronic inflammatory disorder of the lower bowel and colon. It can cause abdominal pain, diarrhea, weight loss, fever, fatigue and rectal bleeding. Its cause in unknown. Between 10 percent and 30 percent of Crohn's sufferers develop one or more abdominal or pelvic abscesses, which are pus-filled pockets.

"Patients develop inflammatory changes in their intestines, which causes little perforations and abscesses to form. They commonly develop this problem," explained Dr. Melvin Rosenblatt, a radiologist at Yale New Haven Hospital in New Haven , Conn.

If an abscess isn't treated, it may grow and result in a dangerous spread of infection.

"The traditional way of treating them has been surgical, where you remove it, and you remove a piece of intestine. And this is an ongoing process that plagues these patients time and time again," Rosenblatt said.

While using a catheter to drain these abscesses isn't a new technique, the study was the largest one to look at the procedure's effectiveness. In this study, the authors researched the medical records of 32 people with Crohn's disease who had the procedure at Massachusetts General Hospital between July 1985 and July 1999.

The researchers checked the medical records of the people for at least 22 months -- the average was seven years -- after they had the procedure.

All but two of 53 abscesses in the 32 people were drained adequately through the catheter, with up to 2 liters of abscess fluid drained. Half of the patients did not require surgery within two months of the procedure. Drainage continued for just over two weeks, on average.

Long-term follow-up found that seven of 31 of the patients didn't need surgery. One patient died of causes unrelated to the study. Seven of the people had a recurrent abscess -- the same number that would be expected after surgery, the researchers say.

The single complication: one person developed a fistula -- an abnormal passage between the abscess and the skin -- after the abscess healed. It was surgically repaired.

PAD is used extensively to treat abscesses in the abdomen, pelvis and chest. It has a high success rate, can be done in a medical center's radiology suite, and is less costly than surgical drainage, the study authors say.

The PAD procedure takes 30 to 60 minutes. The patient is sedated, an ultrasound or CT image is taken of the affected area, and the entry point on the skin is injected with a local anesthetic.

A small incision is made, and the catheter is threaded through the incision. After the catheter is in place, a drainage bag is attached to the outer end. A syringe is used to remove as much material as possible from the abscess.

The tube is left in place, and the person can continue doing the tube drainage at home or it can be done by a visiting nurse.

This study shows PAD can stave off or eliminate the need for surgery to treat abscesses in people with Crohn's disease, Rosenblatt said.

That's important because these abscesses can occur many times.

"If you can save them from having a big operation, you're doing a real good deed," Rosenblatt added.

On the Web

You can find more information about Crohn's disease at the Crohn's and Colitis Foundation of America.

SOURCES: Melvin Rosenblatt, M.D., radiologist, Yale New Haven Hospital , New Haven , Conn. ; March 2002 Radiology
Author: Robert Preidt, HealthDay Reporter
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