Crypt Abscess

What Is It, Causes, Diagnosis, and More

Author:Nikol Natalia Armata

Editors:Alyssa Haag,Ahaana Singh,Kelsey LaFayette, BAN, RN

Illustrator:Jillian Dunbar

Copyeditor:Joy Mapes

What is a 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 (i.e., digestive tract). 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 found within the digestive tract: 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. 

What causes a crypt abscess?

Most often, crypt abscesses form as a response to active inflammation, such as during an infection (e.g., Helicobacter bacterial infection, cytomegalovirus viral infection) 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’s disease and ulcerative colitis. Though crypt abscesses can be found in cases of either condition, they are more commonly identified in ulcerative colitis. Typically, crypt abscesses seen in IBD are neutrophilic.

Less frequently, individuals with colon cancer that undergo radiation of the colon can later develop crypt abscesses. The abscesses can be identified when the colon is examined histologically, through the examination of cellular structures under the microscope. 

Lastly, certain medications, such as the immunosuppressant mycophenolate mofetil, can increase cellular apoptosis, resulting in the formation of crypt abscesses. Abscesses identified in these conditions are mainly apoptotic. 

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How is a crypt abscess diagnosed and treated?

A crypt abscess can be diagnosed histologically, during which a biopsy, or sample, of the gastrointestinal tract is examined under the 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 its underlying cause. In cases involving infections, antibiotics (e.g., metronidazole, ciprofloxacin) are often prescribed. Treatment of cases resulting from IBD may depend on the severity of the disease. 5-aminosalicylic acid compounds, also referred to as mesalamine, are used to treat ulcerative colitis via enema or rectal therapy with suppositories. In more severe cases, oral corticosteroids may be initiated. Individuals who do not 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 (i.e., bleeding), development of fistulas (i.e., connection between two parts of the body that typically do not connect), or enlargement of the abscess -- usually undergo surgical excision of the colon. Lastly, 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.

What are the most important facts to know about a crypt abscess?

Crypt abscesses are the accumulation of inflammatory cells within the crypts of the gastrointestinal tract. There are two types of crypt abscesses: neutrophilic and apoptotic. The main causes of crypt abscesses, including infections and inflammatory bowel disease, involve acute inflammation. Less frequently, crypt abscesses are associated with previous colon radiation and certain medications. When diagnosing a crypt abscess, biopsy is necessary. The treatment largely depends on the underlying cause. 

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Related links

Ulcerative colitis
Inflammatory bowel disease: Pathology review
Colon histology
Crohn’s disease
Inflammatory bowel disease: Clinical practice

Resources for research and reference

Langan, R. C., Gotsch, P. B., Krafczyk, M. A., & Skillinge, D. D. (2007). Ulcerative colitis: Diagnosis and treatment. American Family Physician, 76(9): 1323-1330. 

Nitzan, O., Elias, M., Peretz, A., & Saliba, W. (2016). Role of antibiotics for treatment of inflammatory bowel disease. World Journal of Gastroenterology, 22(3): 1078-1087. DOI: 10.3748/wjg.v22.i3.1078

Talmon, G., Manasek, T., Miller, R., Muirhead, D., & Lazenby, A. (2017). The apoptotic crypt abscess: An underappreciated histologic finding in gastrointestinal pathology. American Journal of Clinical Pathology, 148(6): 538-544. DOI: 10.1093/ajcp/aqx100