Acute Abdomen in Crohn’s disease patients: short- and long-term outcomes

Background: To determine long-term outcome in Crohn’s disease patients hospitalized for acute abdominal pain. Methods: . Retrospective chart review of consecutive Crohn’s disease patients hospitalized for acute abdominal pain at the tertiary referral centre in Eastern Europe. Results: . Between 2015 and 2020, 65 patients with Crohn’s disease were admitted at least once to hospitals’ emergency room because of acute abdominal pain. 13 patients were admitted twice, 8 three times, 3 patients four times and 3 patients five times. Also, the intake of immunosuppressive medication was apparently rare, thus, most patients have been treated by 5-ASA medication only. Most patients had ileal involvement. Two patients presented with an intraabdominal abscess. 53 of 65 patients underwent abdominal imaging during the hospitalization. After hospital admission, 45 patients were treated with antibiotics (65%),17 with steroids (17%), 8 patients received a nasogastric tube and 3 were put on parenteral nutrition. Six patients underwent an intestinal resection during the initial hospitalization (9%). The length of the hospitalization was median 8 days (range, 1 to 115) and it was significantly longer in those, who underwent surgery (mean 28 days vs. 9 days, p = 0.003). Follow-up information was obtained for all patients, and the median follow-up time was 42.8 months. During the follow-up period, 26 patients (40%) readmitted for abdominal emergencies. 14 patients underwent surgery – either at the initial or later hospitalization (21%). Thirteen out of 14 surgeries were emergencies, three were concluded by ostomy formation (21%). One patient developed postoperative intraabdominal complication, however, two patients died postoperatively (14%). By multivariate analysis, complicated disease (stricturing or penetrating) was associated with hospital readmission (Hazard ratio, 5.8, 95% CI: 1.4–23.3; p = 0.013). An elevated C-reactive protein level was associated with a decreased risk of hospital readmission (Hazard ratio,0.08, 95% CI: 0.01–0.55; p = 0.010). Also, complicated disease (stricturing or penetrating) was associated with enhanced probability to undergo intestinal surgery (Hazard ratio, 10.3, 95% CI: 2.4–44.1; p = 0.002) Conclusion: . Ileocolic disease is the main cause of hospitalization for acute abdominal pain. Complicated (structuring or penetrating) disease should be diagnosed early and surveilled closely.