Crypt Abscess

Crypt abscesses are the accumulation of inflammatory cells within crypts, which are tube-like glands found in the lining of the gastrointestinal system, most commonly the colon. The accumulation of inflammatory cells can cause damage to the surrounding cells, thereby preventing the gland from functioning properly and secreting various substances.  

There are two types of crypt abscesses: neutrophilic and apoptotic crypt abscess. Neutrophilic crypt abscesses consist of neutrophils, a type of white blood cell responsible for protecting the body from various infections. Apoptotic crypt abscesses are collections of apoptotic cells, which are cells that have undergone programmed cell death.  

Neutrophilic crypt abscesses form as a response to active inflammation, such as during an infection like due to salmonella, shigella, or Clostridioides difficile, or inflammatory bowel disease (IBD). IBD refers to a group of conditions that are characterized by long-term inflammation of the gastrointestinal tract, including Crohn disease and ulcerative colitis. Though neutrophilic crypt abscesses can be found in various gastrointestinal conditions, they are a hallmark of ulcerative colitis.  

Apoptotic crypt abscesses can occur as a result of graft-versus-host disease, a condition that may affect those who have undergone hematopoietic stem cell transplantation (HSCT), a procedure whereby diseased cells in the bone marrow are replaced with healthy stem cells. The T cells from the donor may attack the recipient’s gastrointestinal lining, resulting in apoptotic crypt abscesses. Individuals with colon cancer that undergo radiation of the colon or receive chemotherapy treatment such as 5-fluorouracil or methotrexate, can later develop crypt abscesses. Other medications, such as the immunosuppressant mycophenolate mofetil, can increase cellular apoptosis, resulting in the formation of apoptotic crypt abscesses.  

A crypt abscess can be diagnosed histologically, during which a biopsy, or sample, of the gastrointestinal tract is examined under a microscope. Usually, biopsy samples are obtained during a colonoscopy, an endoscopic examination of the large intestine and rectum.  

Treatment of a crypt abscess involves diagnosing and treating the underlying cause. For infectious etiologies, antibiotics like metronidazole or ciprofloxacin are often prescribed. Treatment of cases resulting from IBD may depend on the severity of the disease. 5-aminosalicylic acid compounds, including mesalamine or sulfasalazine, administered orally or as an enema or suppository, are used to treat ulcerative colitis. In more severe cases, oral corticosteroids like prednisone may be initiated. Individuals who don’t respond to treatment with oral medication may require hospitalization in order to initiate intravenous administration of steroids.  

Individuals with colon cancer or others who experience complications of crypt abscesses, such as severe hemorrhage, development of fistulas (i.e., connection between two parts of the body that typically don’t connect), or enlargement of the abscess, usually undergo surgical excision of the colon.  

When the formation of crypt abscesses is associated with certain medications, clinicians may recommend discontinuing the use of those medications.  

Less frequently, small crypt abscesses with no complications may resolve on their own.