[Pyoderma gangrenosum mimicking abdominal sepsis after colorectal surgery].
This study reports a case of pyoderma gangrenosum arising at a drainage orifice after a colostomy for cancer. The initial clinical presentation suggested intra-abdominal sepsis but the clinical assessment did not fit with laboratory findings or the CT scan. Forty hours later, the patient developed a reddish-purple ulcer at the drainage orifice. A diagnosis of pyoderma gangrenosum was made and systemic corticosteroid therapy was started. A dramatic response occurred over the next two days, obviating the need for surgical re-intervention. Pyoderma gangrenosum is an ulcerating necrotizing skin disorder of unknown etiology. It usually arises in association with underlying disease (mainly inflammatory bowel disease) and often occurs in para-stomal sites. Pyoderma gangrenosum arising at surgical sites is often mistaken for a postoperative infection and treated inappropriately with debridement and reopening of the wound which only exacerbates the pathology. Pyoderma gangrenosum is effectively treated with systemic corticosteroids.
Hornez
E
E
Service de chirurgie viscérale et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France. emmanuelhornez@free.fr
Monchal
T
T
Ottomani
S
S
Bourgouin
S
S
Platel
J-P
JP
Fournier
B
B
Thouard
H
H
D000230:Adenocarcinoma / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods*; D044683:Colon, Descending / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D018805:Sepsis / Q000175:diagnosis; D016896:Treatment Outcome; D014945:Wound Healing
D005938:Glucocorticoids