title: Clinical features and management of parastomal pyoderma gangrenosum in inflammatory bowel disease.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is often associated with inflammatory bowel disease even after bowel surgery, but it remains an extremely rare pathology. The purpose of this study was to investigate the clinical features and treatment of PG and to consider proper management for peristomal PG.
  
  
  METHODS
  Demographic data for patients who underwent colorectal surgery with ostomy creation at Hyogo College of Medicine between July 2007 and July 2011 were prospectively collected. The main outcome measures were postoperative occurrence of peristomal PG by type: explosive and rapidly spreading type (type R) and indolent and gradually spreading type (type G).
  
  
  RESULTS
  Overall prevalence was 11/738 (1.5%), with type R in 5 patients and type G in 6. Type R and type G were significantly more common in ulcerative colitis and Crohn's disease, respectively (p = 0.01). Type R developed within 6 days after surgery. Type G developed a mean of 52 days after surgery. Complete healing required a long time in both types, with means of 69 days for type R and 48 days for type G.
  
  
  CONCLUSIONS
  Although peristomal PG was a rare complication after surgery, differences in the development of PG were observed between ulcerative colitis and Crohn's disease. Careful observation and knowledge of PG are needed.
authors.affiliation: Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. motoi.uchino@nifty.ne.jp
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D004766:Enterostomy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000627:therapeutic use*; D017511:Pyoderma Gangrenosum / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors; D054047:Surgical Stomas; D013530:Surgical Wound Infection; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011239:Prednisolone; D016559:Tacrolimus