Outcomes of early ileocolectomy after percutaneous drainage for perforated ileocolic Crohn's disease

• Best management for perforated ileocolic Crohn's disease is unclear.
• Early ileocolectomy in perforating Crohn's may have acceptable complication rates.
• Early resection may be associated with the need for a temporary ileostomy.

BackgroundThe optimal treatment for an intra-abdominal abscess/infection secondary to perforating ileocolic Crohn's disease (PCD) is unclear.MethodsForty-seven consecutive PCD patients treated via an institutional protocol of ileocolectomy after a 7-day period of percutaneous abscess drainage were retrospectively compared with 160 consecutive patients who underwent an elective ileocolectomy for Crohn's disease (ECD) between 1992 and 2014. Outcomes were compared using univariate analysis and propensity score matching.ResultsUnivariate analysis demonstrated significant differences in ileostomy rates (PCD: 48.9% vs ECD: 18.8%; P = .001), 30-day readmissions (PCD: 38.3% vs ECD: 18.8%; P = .01), and overall 30-day postoperative complications (PCD: 29.8% vs ECD: 15%; P = .03). After matching, a statistically significant difference was retained in ileostomy rates (P = .02) and 30-day readmissions (P = .01).ConclusionsEarly operative intervention after percutaneous drainage in perforating CD may be associated with a high incidence of diversions and readmissions.