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Clinical Features and Management of Parastomal Pyoderma Gangrenosum in Inflammatory Bowel Disease

Uchino M.a · Ikeuchi H.a · Matsuoka H.a · Bando T.a · Takahashi Y.b · Takesue Y.b · Matsumoto T.c · Tomita N.a
aDepartment of Surgery, bDivision of Infection Control and Prevention, and cDivision of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Digestion 2012;85:295–301 (DOI:10.1159/000336719)

Abstract

Background: Pyoderma gangrenosum (PG) is often associated with inflammatory bowel disease even after bowel surgery, but it remains an extremely rare pathology. The purpose of this study was to investigate the clinical features and treatment of PG and to consider proper management for peristomal PG. Methods: Demographic data for patients who underwent colorectal surgery with ostomy creation at Hyogo College of Medicine between July 2007 and July 2011 were prospectively collected. The main outcome measures were postoperative occurrence of peristomal PG by type: explosive and rapidly spreading type (type R) and indolent and gradually spreading type (type G). Results: Overall prevalence was 11/738 (1.5%), with type R in 5 patients and type G in 6. Type R and type G were significantly more common in ulcerative colitis and Crohn’s disease, respectively (p = 0.01). Type R developed within 6 days after surgery. Type G developed a mean of 52 days after surgery. Complete healing required a long time in both types, with means of 69 days for type R and 48 days for type G. Conclusion: Although peristomal PG was a rare complication after surgery, differences in the development of PG were observed between ulcerative colitis and Crohn’s disease. Careful observation and knowledge of PG are needed.

 

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