Parastomal pyoderma gangrenosum in inflammatory bowel disease.
OBJECTIVE
Parastomal pyoderma gangrenosum is uncommon and its association with inflammatory bowel disease is unclear. This is a review of five patients with parastomal pyoderma gangrenosum.


METHODS
A retrospective review of five patients with ulcerative colitis (two patients) or Crohn's disease (three patients) who have been seen in one surgical unit was conducted.


RESULTS
All patients were females and each presented within nine months of abdominal surgery and stoma construction. All had active proctitis (n = 3) or perianal Crohn's disease (n = 2). Both patients with perianal Crohn's disease had a mild clinical course with healing of parastomal pyoderma gangrenosum when treated with steroids with and without low-dose cyclosporin A. They both had curettage of the perineal wound as well. In the remaining three patients with active proctitis, the parastomal lesions failed to resolve despite high-dose systemic steroids. By contrast, the parastomal pyoderma gangrenosum healed promptly in two of these patients following proctectomy for active proctitis.


CONCLUSIONS
The variable clinical outcome of parastomal pyoderma gangrenosum may be related to the activity of the underlying inflammatory bowel disease or possibly to low-grade perineal sepsis.
Tjandra
J J
JJ
Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom.
Hughes
L E
LE
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000601:surgery*; D003475:Curettage; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis; D017511:Pyoderma Gangrenosum / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing
D013256:Steroids; D016572:Cyclosporine