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Intra-abdominal abscesses and entero-enteric fistulas are severe penetrating complications of paediatric Crohn’s disease, associated with significant morbidity, prolonged hospitalisation, and complex multidisciplinary management. 1 Although guidance supports early biologic therapy and nutritional optimisation in penetrating disease, paediatric outcome data for internal fistulas and abdominal abscesses remain limited.2This retrospective cohort study aimed to evaluate the clinical characteristics, management, and outcomes of penetrating paediatric Crohn’s disease (intra-abdominal abscess, enteroenteric fistula (EEF), or both).Patients with radiologically confirmed intra-abdominal abscess and/or EEF between 2022 – 2025 were identified from the Paediatric Inflammatory Bowel Disease (PIBD) database with data collected on age at diagnosis, age and disease duration at complication onset, inflammatory markers, nutritional support, imaging modality, management and outcomes. Outcomes included resolution, recurrence, need for surgery, biologic escalation, and length of stay (LOS). Median radiological follow-up duration was 8 weeks (range 2–26) for abdominal abscesses and 19 weeks (range 4–52) for EEF.A total of 16 had penetrating (B3) disease characterised by EEF and/or intra-abdominal abscess. 4/16 (25%) had intra-abdominal abscess only, 6/16 (37.5%) had EEF only, and 6/16 (37.5%) had both. Median age at diagnosis was 13.5 years, and median age at complication was 14.5 years. Median disease duration at complication occurrence was 2.5 months. Exclusive Enteral Nutrition (EEN) was required in 12/16, parenteral nutrition in 4/16 (duration 3 – 112 days, median 28 days).All 10 abscess patients received antibiotics (100%), 3/10 (30%) underwent percutaneous drainage, and 1/10 (10%) required a diverting stoma. At follow up, clinical resolution was 100%, and radiologic resolution 90%. Abscess recurred in 20%.Of 12 children with EEF, 10/12 (83%) received antibiotics, 12/12 (100%) received nutritional support, and 1 (8.3%) required bowel resection. At follow up, radiologic fistula closure occurred in 6/12 (50%), with no recurrences.Biologic therapy was initiated in 13/16 patients (81.3%) following complication onset, while the remaining 3/16 (18.7%), who were already receiving biologics, required switching of therapy.Length of stay ranged from 12–80 days (median 46 days) in abscess only cases, 14–150 days (median 44.5 days) in patients with both abscess and EEF, and 4–17 days (median 14 days) in EEF-only cases. No mortality occurred.This shows favourable short-term outcomes in penetrating PIBD with abscess resolution, fistula closure in half, and low recurrence. Nutritional support and early biologic use were central to management. The short interval between disease onset and complication supports the use of early biologics. Abscess related disease imposed the greatest hospital burden, reinforcing the importance of multimodal care.References Van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis. 2014;8(10):1179–1207.Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric Crohn’s disease: an updated ESPGHAN guideline. J Pediatr Gastroenterol Nutr. 2021;72(2):320–335.