Management of peristomal pyoderma gangrenosum.
BACKGROUND
Pyoderma gangrenosum (PG) occurs in about 1% to 5% of patients with inflammatory bowel disease (IBD). Peristomal pyoderma gangrenosum (PPG) is particularly difficult to manage.


METHODS
A retrospective chart review was performed on all patients with IBD in whom PPG developed from 1997 to 2007 at the Milton S Hershey Medical Center.


RESULTS
Sixteen patients (11 women) were identified. Seven had Crohn's disease (CD), seven had ulcerative colitis (UC), and two had indeterminate colitis. Six patients underwent total proctocolectomy, six patients had total abdominal colectomy (TAC), and four patients had diverting loop stomas. PPG occurred an average of 18.4+/-7.5 months after stoma creation. Twelve patients had active IBD when PPG developed. Two patients had stoma revisions and both had recurrence of the PPG with the new stoma. Medical therapy was successful in eight patients. Five patients had their stomas closed, with active PPG, and all five resolved their lesions. In four of five, surgical management was altered because of PPG (one early stoma closure, two ileal pouches without stomas, one ileal pouch with high body mass index). Of the seven and six patients treated with cyclosporine or infliximab, respectively, there were only two successes with each.


CONCLUSIONS
PPG is more common in the presence of active IBD. Surgical closure of the stoma was successful in resolving PPG in all patients. Cure rate of PPG was poor with cyclosporine and only marginally better with infliximab. Medical treatment of PPG is imperfect, and the best therapy is stoma closure when possible.
Poritz
Lisa S
LS
Division of Colon and Rectal Surgery, The Milton S Hershey Medical Center, Hershey, PA 17033, USA.
Lebo
Marjorie A
MA
Bobb
Anne D
AD
Ardell
Christine M
CM
Koltun
Walter A
WA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003082:Colectomy; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000628:therapy; D008297:Male; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*; D013536:Suture Techniques; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents