Scrotal abscesses in perianal Crohn’s disease: a retrospective cohort study of clinical presentation, management, and outcomes

BACKGROUND: Perianal Crohn's disease (pCD) is a severe phenotype frequently complicated by fistulas and recurrent abscesses. Although perianal sepsis is well described, genital involvement is rare, with scrotal abscesses previously reported only in case reports. Consequently, their presentation, management, and outcomes remain poorly understood. METHODS: We conducted a retrospective cohort study of male patients with Crohn's who developed scrotal abscesses between January 1, 2009, and October 31, 2024, at our quaternary referral center. Clinical records were reviewed for demographics, disease phenotype, abscess characteristics, diagnostic modality, management, microbiology, and clinical outcomes. RESULTS: (IQR 22.3-31.4). Most patients had colonic disease (57.5%) and long-standing Crohn's disease. Prior Crohn's-related abscesses occurred in 82.5%, and 37.5% had a history of perianal seton placement. Abscesses were most commonly right-sided (57.5%), and 35% of patients had a scrotal fistula. Diagnosis was most frequently established using computed tomography (32.5%). All patients received antibiotics; 30% underwent bedside incision and drainage, and 37.5% underwent operative drainage. Hospital admission was required in 60%, recurrence within 12 months occurred in 40%, and escalation of advanced therapy in 20%. During follow-up, 35% required fecal diversion (72% or 25% overall), and 20% underwent proctectomy. CONCLUSION: Scrotal abscesses are an uncommon but clinically significant complication of pCD, occurring in patients with severe perianal disease and are associated with substantial morbidity. Early recognition and multidisciplinary management are essential for successful outcomes.