Peristomal Pyoderma Gangrenosum Research Articles

Ileostomy: Early and Late Complications

Abstract Introduction Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases. Materials and Methods We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review. Results/Discussion Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation. Conclusion Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor.

Clinical efficacy of crushed prednisolone and hydrocolloid powder in the primary treatment of peristomal pyoderma gangrenosum and correlation to in vitro drug release data.

We evaluated the primary application of crushed prednisolone combined with hydrocolloid powder for clinically diagnosed peristomal pyoderma gangrenosum (PPG). We present our data on this cohort and follow-up of our previous patients. Of the 23 patients who were commenced on this regime, 18 healed (78%). Twenty-two patients commenced on this regime as the primary treatment for their PPG, and for one, it was a rescue remedy after failed conventional therapy. Four patients with significant medical comorbidities failed to heal and one had their stomal reversal surgery before being fully healed. The proposed treatment regime for PPG is demonstrated to be effective, inexpensive and able to be managed in the patient's usual home environment. In vitro drug release analysis was undertaken, and data are presented to provide further insights into the efficacy of this regime.

Multimodal therapy for peristomal pyoderma gangrenosum with topical cyclosporine

Pyoderma gangrenosum (PG) is arare neutrophilic disease. Clinically it shows arapidly evolving painful ulceration with undermined violaceous wound edges. Peristomal PG is particularly resistant to treatment due to mechanical irritation. Two cases illustrate amultimodal therapeutic concept based on topical cyclosporine, hydrocolloid dressing and systemic glucocorticoids. In one patient re-epithelialization was attained after 7weeks and the other patient experienced downsizing of the wound edges over 5months.

Peristomal pyoderma gangrenosum successfully treated with cyclo-sporine

Peristomal pyoderma gangrenosum (PPG) is an uncommon subtype of pyoderma gangrenosum. We describe a 74-year-old woman without inflammatory bowel disease (IBD) who developed PG around the jejunostomy and was successfully treated with cyclosporine. In our case, irritations by a lumbar corset and repeated sutures around the jejunostomy seemed to have caused pathergy reaction. It is noteworthy that 20% of PPG patients do not have IBD and therefore patients presenting PPG without IBD should not be overlooked.

Diagnosis and Treatment Difficulty in Early-Onset Peristomal Pyoderma Gangrenosum Associated With Ulcerative Colitis: A Case Report

Peristomal pyoderma gangrenosum (PPG) is a rare dermatological condition associated with gastroenterological disease. Most gastrointestinal surgeons find it difficult to suspect and treat PPG, especially at early onset. The patient was an 18-year-old female. The patient underwent three-stage restorative proctocolectomy for refractory ulcerative colitis. On postoperative day (POD) 9, the trocar wound near the ileostomy site dehisced. Because the wound culture was positive, the wound was treated with an antibacterial agent as an infection. However, the wound worsened. The patient was referred to a dermatologist for diagnosis. PPG was diagnosed on POD 37. Wound management was initiated using topical steroids. The wound caused difficulties in pain and dressing management. Although infliximab was administered as a systemic therapy, it was discontinued because of allergic symptoms. Sealing therapy with hydrofiber dressing and adequate stoma pouching with stoma paste provided good exudate absorption and a clean environment by protecting the wound from stoma excretion. Oral prednisone was initiated on POD 82. Improvement in the wound condition was observed with a prednisone dose of 30 mg/day. Complete remission was achieved seven months after onset. Twelve months after the surgery, stoma closure was performed. The local cutaneous condition remained in remission without exacerbation. Suspicion of PPG can be difficult when it develops early after stoma creation. We never forget that PPG should be suspected when a progressive ulcerative lesion is found around the stoma, even early after operation. If PPG is suspected, a multidisciplinary team plays an essential role in its diagnosis and management.

DOP32 Biologic treatment does not reduce the risk of postoperative peristomal pyoderma gangrenosum in Crohn’s Disease patients

Abstract Background To assess the risk of postoperative peristomal pyoderma gangrenosum in Crohn’s disease patients undergoing bowel resection with formation of an ostomy. Methods All patients with Crohn’s disease undergoing intestinal resection with formation of an ostomy were included in the present retrospective analysis. The data collection was performed prospectively. All cases of pyoderma gangrenosum were identified by clinical examination and documented on photographs. “Extended colectomies” were total colectomy and proctocolectomy. Results Between 2009 and 2021, 99 patients underwent intestinal resections with formation of an ostomy – 95 ileostomies and 4 colostomies. Ileocolic resections were performed in 62 patients, small bowel resections in 2 and colorectal resections in 35 patients. Additional abdominoperineal rectal resections were performed in 19 out of latter 35 patients. At the time of surgery, 31 patients were on biological treatment, 19 on steroids. Postoperatively, 10 patients (10%) developed peristomal pyoderma gangrenosum – all during first 3 postoperative months and all in presence of an ileostomy. By univariate analysis, abdominoperineal resection (26% vs. 9%, p=0.03), presence of colonic disease (20% vs. 2%, p=0.005), preoperative biological treatment (24% vs. 4%, p=0.008), extended colectomy (27% vs. 5%, p=0.008), non-stricturing/non-penetrating disease (35% vs. 5%, p=0.002) were associated with an increased risk of peristomal pyoderma gangrenosum. By multivariate analysis, preoperative intake of biologic treatment (Hazard Ratio 5.5, p=0.03), and non-stricturing/non-penetrating disease (HR 8.3, p=0.006) were associated with the risk of postoperative pyoderma gangrenosum. Conclusion Crohn’s disease patients with colonic disease undergoing bowel resections for non-stricturing/non-penetrating disease are at high risk to develop peristomal pyoderma gangrenosum during the early postoperative period. Preoperative biological treatment does not decrease the risk of pyoderma formation; moreover, it might even increase it.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

Budesonide capsules for peristomal pyoderma gangrenosum

Peristomal pyoderma gangrenosum is an uncommon complication occurring after ileostomy or colostomy placement, especially in patients with ulcerative colitis or Crohn disease. Compared with inflammatory bowel disease, stoma complications have been noted in 6% of inpatients with pyoderma gangrenosum, and they cause an increase in the length of stay by 2.67 days.1 A combination of local and systemic therapy is often used. However, vehicle selection for its local treatment is challenging because of the need to provide a local anti-inflammatory agent that causes minimal pain and does not disrupt pouch adhesion. Corticosteroids applied in cream, ointment, oil, and gel forms interrupt the adhesion of the pouch.

Health-related domains of quality of life in pyoderma gangrenosum: A qualitative analysis

Health-related domains of quality of life in pyoderma gangrenosum: A qualitative analysis

Peristomal pyoderma gangrenosum in a patient with inflammatory bowel disease

Peristomal pyoderma gangrenosum in a patient with inflammatory bowel disease

Topical Management of Peristomal Pyoderma Gangrenosum: A Report of 3 Case Studies.

Peristomal pyoderma gangrenosum (PPG) presents multiple challenges for healthcare providers. The diagnosis of PPG may be delayed, and it may be mistaken for an irritant dermatitis or an infection. Patients with ostomies secondary to inflammatory bowel disease (IBD) may experience PPG. Issues related to PPG include difficulty maintaining a seal of the ostomy pouching system and preventing contamination of the painful, necrotic ulcerations characteristic of this condition. Treatment focuses on the appropriate assessment of the ulcers, successful pouch application, and proper management of IBD through a collaborative effort of both dermatologists and certified WOC nurses (CWOCN). We treated 3 patients diagnosed with Crohn's disease (CD) who developed refractory PPG. All 3 were treated with a topical steroid lotion, prednisone, and adalimumab or a combination of these agents. Ostomy products and application were tailored to prevent leakage and protect areas of ulceration. All ulcers were healed within 6 months of our initial consultation. We successfully managed 3 patients with CD and PPG with appropriate ostomy care, including revision of the ostomy pouching techniques, topical steroid treatment, and treatment based on assessment of ulcer status by the dermatologist and the WOC nurse.

Colorectal carcinoma, chemotherapy and peristomal pyoderma gangrenosum: A rare association

Colorectal carcinoma, chemotherapy and peristomal pyoderma gangrenosum: A rare association

Expert Commentary on the Management of Peristomal Pyoderma Gangrenosum in a Patient With IBD.

Expert Commentary on the Management of Peristomal Pyoderma Gangrenosum in a Patient With IBD.

Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease.

Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD). To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort. Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG. The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P=0.006), had higher BMIs (29.78±0.89 vs 23.53±0.51, P<0.0001) and had increased usage of pouch belts (97% vs 71%, P=0.0008) compared to controls. There were no differences in age at surgery (41.76±2.60 vs 43.49±1.50, P=0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P=0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%). Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.

Diagnosis and treatment of peristomal pyoderma gangrenosum: a case report

Gastrointestinal NursingVol. 18, No. Sup4 CommentDiagnosis and treatment of peristomal pyoderma gangrenosum: a case reportMargarete Anna WieczorekMargarete Anna WieczorekContactE-mail Address: [email protected]Wound Ostomy and Continence Nurse at Hospital of the Order of St John of God, Regensburg, GermanySearch for more papers by this authorMargarete Anna WieczorekPublished Online:23 May 2020https://doi.org/10.12968/gasn.2020.18.Sup4.S10AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Al Ghazal P, Herberger K, Schaller J et al.. Associated factors and comorbidities in patients with pyo-derma gangrenosum in Germany: a retrospective multicentric analysis in 259 patients. Orphanet J Rare Dis. 2013; 8:136. https://doi.org/10.1186/1750-1172-8-136 Crossref, Google ScholarBrooklyn T, Dunnill G, Probert C. Diagnosis and treatment of pyoderma gangrenosum. BMJ. 2006; 333(7560):181–184 Crossref, Google ScholarGameiro A, Pereira N, Cardoso JC, Gonçalo M. Pyoderma gangrenosum: challenges and solutions. Clin Cosmet Investig Dermatol. 2015; 8:285–293. https://doi.org/10.2147/CCID.S61202 Crossref, Google ScholarHofmann G, Summa S. Pyoderma gangraenosum (Dermatiis ulcerosa). Gruber G (ed). Uniform care for patients with ostomy: practice and advice – inpatient and outpatient [in German]. Berlin Hei-delberg: Springer-Verlag; 2017 Google ScholarQuist SR, Kraas L. Therapy options for pyoderma gangrenosum [in German]. J Dtsch Dermatol Ges. 2017; 15(1):34–41. https://doi.org/10.1111/ddg.13173_g Google Scholar FiguresReferencesRelatedDetails 1 May 2020Volume 18Issue Sup4ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 23 May 2020 Published in print 1 May 2020 Information© MA Healthcare LimitedPDF download

Peristomal pyoderma gangrenosum in patients who underwent colectomy and colostomy for incurable inflammatory bowel disease

Peristomal pyoderma gangrenosum in patients who underwent colectomy and colostomy for incurable inflammatory bowel disease

A novel topical therapy for resistant and early peristomal pyoderma gangrenosum.

Peristomal pyoderma gangrenosum (PPG) is an under-recognised and difficult condition to treat. We describe a case series using a novel topical combination therapy that promotes wound healing and allows for adhesion of the stoma appliance. A crushed oral prednisolone tablet mixed with Stomahesive Protective Powder (ConvaTec) was applied topically to seven patients with PPG and resulted in pain relief and wound healing in six of seven patients. Only one patient experienced recurrence. The novel topical therapy we describe is cost-effective, readily available, and easily applied in any inpatient or outpatient setting.

Ostomy Complications in Crohn's Disease.

Ostomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum.

Peristomal pyoderma gangrenosum in a patient with chronic ulcerative colitis: Case report

Peristomal pyoderma gangrenosum in a patient with chronic ulcerative colitis: Case report

Peristomal pyoderma gangrenosum: 12‐year experience in a single tertiary referral centre

Peristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage. This was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence. Of 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19-72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14-2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3-31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti-inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28-1751 days). Medical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.