Twenty Cases of Peristomal Pyoderma Gangrenosum

摘要: Hypothesis: Our experience with peristomal ulcers suggested that pyoderma gangrenosum (PPG) is an infrequent and usually unrecognized complication of inflammatory bowel disease. We hypothesized a review our PPG would clarify the essentials its diagnosis, evaluation, treatment. Design: A case series 20 consecutive patients complicating disease were treated at institution between 1986 1999. There 15 women 5 men. At time development pyoderma, 10 had diagnosis Crohn (CD), while 9 ulcerative colitis (UC). One patient was diagnosed as having CD only after first developing PPG. Main Outcome Measure: Healing Interventions: All failed local enterostomal care prior to referral. Debridements and/or stomal revisions uniformly unsuccessful. Biopsies, when performed, did not provide clinically important information. Treatment directed toward disease, variable clinical responses corticosteroids, metronidazole, cyclosporine, sulfasalazine, infliximab. Results: Ultimately, 13 CD. Of these patients, 12 (92%) developed coincident recurrent Two remote history proctocolectomy for UC subsequent evaluation revealed adjacent urinary Kock pouch cystectomy; ultimately, made. No lost follow-up, but in 1 UC, no latent carried out. The final (65%) 7 (35%) patients. healed completely, within average 11.4 months (median, 8 months; range, 1-41 months). Ulcer resolution achieved medical therapy alone 14 (70%) cases. Resection active gastrointestinal resulted healing (83%) 6 2 conservative only. Conclusions: This largest reported suggests following: (1) uncommon often misdiagnosed by clinicians; (2) wound measures have little role PPG; (3) heralds CD; (4) indicates until proven otherwise; (5) prolonged (11 months), immunosupression, required (6) if feasible, surgical resection all leads ulcers.