Procedures to Drain Abscesses

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Abscesses are a relatively common complication of inflammatory bowel disease (IBD). Of the two main forms of IBD, around 10 to 30 percent of people with Crohn’s disease (CD) develop abscesses, and around 20 percent of people with ulcerative colitis (UC) develop them. Because people with IBD have chronic inflammation in their digestive tracts, the inflammation can spread deep into the walls of the intestines and cause an infection.1,2

Abscesses form when the infected area becomes filled with pus, which is a fluid containing white blood cells, dead tissue, and bacteria.3

Where do abscesses happen?

Abscesses can happen in many different parts of the body, but the most common locations for abscesses due to IBD are in the abdomen, pelvis, or anal areas. For example:

  • Where the small intestine joins the large intestine (the ileum)
  • The place where the intestine is reattached after bowel resection surgery (the anastomosis)
  • In the area behind an intestinal blockage
  • In and around fistulas
  • Near the anus or rectum

Abscesses can cause symptoms such as:

  • Pain in the abdomen or pelvis
  • Fever
  • Painful bowel movements
  • Discharge of pus from the anus
  • A bump on the edge of the anus that is inflamed or tender

How are abscesses treated?

Abscesses will typically need to be surgically drained of pus in order for them to heal.1 Abscesses can be drained using open surgery, in which an incision is made in the patient’s abdominal, pelvic, or anal area and the abscess is drained during the procedure, However, when possible, surgeons will usually try to use a minimally invasive procedure called percutaneous abscess drainage.

What is percutaneous abscess drainage?

During the percutaneous abscess drainage procedure, the surgeon uses imaging technology to locate the abscess and make a small incision near it.1 A thin tube called a “catheter” is inserted through the incision and into the abscess to allow the fluid to drain out.

What happens after percutaneous abscess drainage?

After the procedure, the catheter may be left in place for a week or more to make sure that all of the fluid has a chance to drain.1 However, patients usually start feeling better within a couple of days. During the recovery period, the patients usually take antibiotics to treat the infection as well. After the infected fluid is completely drained from the abscess, the catheter is removed.

Even after the abscess is drained, some patients may need to continue treatment for several months with high-dosage antibiotics at home. In those cases, the antibiotics are delivered through a port or what is called a “picc line” (peripherally inserted central catheter), which is a catheter that stays in place in the body to deliver medicine over a long period of time.

Is surgery needed for abscesses?

In many cases, the abscess heals very well when it is drained and the infection is treated. However, some patients will eventually develop another infection in the same abscess area. Depending on the severity of the abscess and where it is located, some patients may need to have further surgery to remove the diseased area of the intestine where the abscess was located. This is called bowel resection surgery.

One of the reasons that it is important to treat abscesses quickly is that they can go on to cause fistulas around the area where the abscess has formed. People who have abscesses with fistulas are more likely to need surgery to treat them. Fistulas and abscesses are also complications that can occur after other types of surgery for CD, such as bowel resection surgery.

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