General session VII Moderated by Chifumi Yoshida: A Case of Ulcerative Colitis with Peristomal Pyoderma Gangrenosum

Abstract

Introduction: Pyoderma gangrenosum is a skin disease that can result in progressive necrosis and formation of painful ulcers. This is to report on a case where the patient developed the disease around a stoma.Case: A 40‐year‐old female patient developed ulcerative colitis (UC) when she was 25. At the age of 38, the exacerbation of UC required a colectomy and ileal pouch anal canal anastomosis (IACA), following which, a permanent ileostomy was constructed due to pouchitis. In April 2003, she developed redness around the stoma with pain, which resulted in the gradual formation of an ulcer. She was hospitalized with a diagnosis of peristomal pyoderma gangrenosum (PPG). After admission to the hospital, the dosage of predonine was increased to 30 mg/day, and dapsone was concomitantly administered. Clobetasol propionate and sulfadiazine silver were topically administered 1–4 times daily. The wound region adjacent to the stoma was protected with a gauze dressing. Although the gauze was changed each time, it was contaminated with fecal matter, the suffering thereby inflicted on the patient was too severe due to the associated smell and staining of her clothing. For this reason, she alternatively started wearing a stoma bag, which enabled periodic replacement once daily. Following a gradual improvement of the ulcer, she was discharged from the hospital two months after admission. Her recovery was confirmed four months after onset.Conclusion: PPG is accompanied by pain, and treatment also involves suffering by the patient. We need to make the diagnosis and determine the treatment method while the disease is still in its early stages. The selection of the method of care should be made with consideration of the practical aspect of the patient's defecation control.