{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T14:03:44Z","timestamp":1785074624457,"version":"3.55.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Encountering an intra-abdominal abscess during elective surgery for Crohn disease (CD) presents a clinical dilemma. While guidelines often recommend temporary fecal diversion, stomas carry substantial morbidity. Existing literature is heavily confounded by selection bias, obscuring the true safety of bowel reconstruction. This study evaluated the safety of primary anastomosis in the presence of an intraoperative abscess.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of patients undergoing ileocecal resection for CD was conducted. To isolate the impact of the abscess and eliminate selection bias, an a priori multivariable logistic regression model and a 1:2 propensity score matched (PSM) analysis were utilized on the subcohort of patients who underwent primary anastomosis. The primary endpoint was the rate of 30-day postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 810 included patients (210 with an intraoperative abscess, 600 without), an abscess significantly increased operative complexity, resulting in higher rates of open conversion (29.3% vs 10.3%, P\u2009&amp;lt;\u2009.001) and fecal diversion (24.8% vs 6.2%, P\u2009&amp;lt;\u2009.001). However, multivariable analysis demonstrated that an abscess was not an independent predictor of overall 30-day complications (odds ratio [OR], 1.25; P\u2009=\u2009.190). Furthermore, in the PSM cohort of 474 patients, rates of anastomotic leak (10.1% vs 11.7%, P\u2009=\u2009.718), overall complications (41.1% vs 38.0%, P\u2009=\u2009.571), and severe complications (8.2% vs 10.8%, P\u2009=\u2009.480) were statistically identical between the abscess and non-abscess groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While an intraoperative abscess increases operative difficulty, it does not independently compromise anastomotic integrity. Primary anastomosis in an infected field is safe, allowing surgeons to spare appropriately selected patients at experienced centers the profound morbidity of an unnecessary stoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izag148","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:30:18Z","timestamp":1783337418000},"source":"Crossref","is-referenced-by-count":0,"title":["The hostile abdomen dilemma: the safety of primary anastomosis in the presence of an intraoperative abscess in Crohn disease"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4439-5254","authenticated-orcid":false,"given":"Tommaso","family":"Violante","sequence":"first","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]},{"name":"Division of Colon and Rectal Surgery, Mayo Clinic , Rochester, MN,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8870-5176","authenticated-orcid":false,"given":"Stefano","family":"Cardelli","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7460-9578","authenticated-orcid":false,"given":"Giacomo","family":"Calini","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-7797","authenticated-orcid":false,"given":"Marco","family":"Novelli","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Mayo Clinic , Rochester, MN,","place":["United States"]},{"name":"Department of Statistical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Coscia","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Paola","family":"Pezzuto","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Rosati","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolas Konstantine","family":"Dussias","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]},{"name":"Inflammatory Bowel Disease (IBD) Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Rizzello","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]},{"name":"Inflammatory Bowel Disease (IBD) Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0278-4139","authenticated-orcid":false,"given":"Matteo","family":"Rottoli","sequence":"additional","affiliation":[{"name":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum\u2014University of Bologna , Bologna,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"2026072609484173800_izag148-B1","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/s10151-024-02985-5","article-title":"Assessing robotic-assisted surgery versus open approach in penetrating Crohn\u2019s disease: advantages and outcomes in ileocolic 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