skip to main content

Penetrating Crohn's disease with abscess — ESEGH MCQ

Instant feedback + full explanation. One question, done properly.

HardInflammatory Bowel DiseasePenetrating Crohn's disease with abscessESEGH

A 29-year-old man with ileocolonic Crohn's disease presents with fever and right iliac fossa pain. He is taking adalimumab. CRP is 156 mg/L and CT abdomen shows active terminal ileitis with a 5 cm adjacent abscess. There is no free perforation. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: B — Antibiotics with radiological abscess drainage before escalation of immunosuppression

An intra-abdominal abscess in Crohn's disease should be controlled with antibiotics and drainage where feasible before intensifying immunosuppression. Increasing anti-TNF or giving steroids before sepsis control risks clinical deterioration. Balloon dilatation is for selected fibrotic strictures rather than abscess. The teaching point is that penetrating Crohn's needs source control as much as anti-inflammatory therapy.

Reference: BSG IBD Guideline 2025; ECCO Crohn's Disease Guidance