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Crohn's intra-abdominal abscess — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyCrohn's intra-abdominal abscessSCE Acute Medicine

A stable patient taking prednisolone for Crohn disease has a 5 cm right-iliac-fossa abscess without free perforation. What is the next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give intravenous antibiotics and arrange image-guided drainage

The best answer is “Give intravenous antibiotics and arrange image-guided drainage”. This is correct because a drainable collection needs source control and antimicrobial therapy before immunosuppression is escalated. Surgery is required when drainage is impossible, perforation occurs or sepsis persists. Steroids and biologics can worsen uncontrolled infection, and colonoscopy during an acute penetrating complication adds risk.

Reference: British Society of Gastroenterology inflammatory-bowel-disease guideline: https://www.bsg.org.uk/clinical-resource/bsg-guidelines-on-ibd-in-adults-2025