S698 Corticosteroids Are Not Associated With Worse Outcomes for Crohn's Disease Patients With Phlegmon

Introduction: Crohn's disease (CD) inflammation may extend through the entire thickness of the bowel wall causing a vague inflammatory mass referred to as a phlegmon. While this may be due to microperforation, it is disorganized and does not meet imaging criteria of an abscess. Abscess management involves antibiotics and drainage, with use of corticosteroids (CS) discouraged. The use of CS for phlegmon remains controversial, and has only been analyzed by a few small case series which included patients with abscesses. Our goal was to examine the effects of CS treatment for patients with CD and phlegmon without an abscess. Methods: A retrospective study/natural language search was conducted of all inpatient CT scan reports within the Northwell Health system from 01/01/2015 to 12/31/2019 using the terms “phlegmon” or “inflammatory mass”. This group was then cross referenced for ICD9/10 codes for CD, followed by direct review of CT reports for an affirmative finding of phlegmon or inflammatory mass, excluding those with an abscess. Records were reviewed for demographic data and treatment before and during hospitalization. Outcomes examined included 90-day readmission rates, and surgery within one year of hospitalization. Results: A search of 7,936 CT reports found 220 patients with CD and phlegmon, 110 of whom had no associated abscess. Pre-admission 15.45% of patient used antibiotics, 36.36% CS, and 33. 64% biologic therapy (see Table 1). 20% of patients had signs of small bowel obstruction (SBO) on CT. During hospitalization 92.73% received antibiotics, 59.09% CS, and 39.09% biologic therapy. Overall, 57 (51.82%) patients underwent surgery within one year. Readmission by 90 days also occurred in 51% of cases. Patients receiving CS either pre or post admission had similar outcomes to those not receiving CS. Inpatient use of biologic therapy was associated with an increased risk of surgery within one year 67.44 % (p=0.0086), but not 90-day readmission rates. Presentation with SBO was not associated with either risk of surgery or 90-day readmission. Conclusion: Among CD patients admitted with a phlegmon we did not observe any adverse outcomes related to the use of CS. The increased surgical interventions seen in those with biologic use likely reflects selection of a refractory disease subgroup, rather than a true adverse effect of the medication. Our findings suggest that treatment with CS in setting of CD with phlegmon does not increase risk of surgery or readmission.Table 1.: Demographic characteristics and humoral immune response by medication class to COVID-19 vaccination among individuals with IBD enrolled in PREVENT-COVID study.