title: [Pyoderma gangrenosum mimicking abdominal sepsis after colorectal surgery].
abstract: 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.
authors.affiliation: Service de chirurgie viscérale et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France. emmanuelhornez@free.fr
authors.forename: E
authors.initials: E
authors.lastname: Hornez
authors.forename: T
authors.initials: T
authors.lastname: Monchal
authors.forename: S
authors.initials: S
authors.lastname: Ottomani
authors.forename: S
authors.initials: S
authors.lastname: Bourgouin
authors.forename: J-P
authors.initials: JP
authors.lastname: Platel
authors.forename: B
authors.initials: B
authors.lastname: Fournier
authors.forename: H
authors.initials: H
authors.lastname: Thouard
mesh_terms: 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
chemical_list: D005938:Glucocorticoids