Related Experiment Videos
Parastomal pyoderma gangrenosum: a case report and literature review
Gregory J Mancini1, Lennis Floyd, Julio A Solla
1Graduate School of Medicine, Department of Surgery, University of Tennessee Medical Center, Knoxville 37920, USA.
Abstract:
Parastomal pyoderma gangrenosum (PPG) is an exceedingly rare disease process most often observed in inflammatory bowel disease patients with an ileostomy. Fewer than 50 cases have been reported in the medical literature. The incidence is 0.6 per cent of patients with ileostomy and inflammatory bowel disease. The rarity of the disease leads to misdiagnosis and mistreatment of the lesion. The intense pain and disruption of ostomy function greatly impair affected individuals beyond the limit of their underlying disease. Current best care practices observed in small study series indicate long-term intensive medical therapy aimed at systemic disease suppression to optimize PPG wound healing. Our patient had no signs of active Crohn disease at the time of PPG presentation. She was initially treated with minimal wound debridement and intralesional triamcinolone. Finally under the care of an enterostomal/wound care therapist the patient achieved excellent PPG resolution in 6 months.
Insights
Parastomal pyoderma gangrenosum (PPG) is a rare condition affecting ileostomy patients. Intensive therapy and specialized wound care led to successful resolution in this case.
Area of Science:
- Dermatology
- Gastroenterology
- Surgical Ostomy Care
Background:
- Parastomal pyoderma gangrenosum (PPG) is a rare ulcerative skin condition.
- It predominantly affects patients with inflammatory bowel disease (IBD) and an ileostomy.
- Fewer than 50 cases are documented, with an incidence of 0.6% in IBD patients with ileostomies.
Observation:
- PPG presents with intense pain and disrupts ostomy function, significantly impacting patient quality of life.
- Misdiagnosis and mistreatment are common due to the condition's rarity.
- The reported patient had no active Crohn disease at the time of PPG onset.
Findings:
- Initial treatment involved minimal debridement and intralesional triamcinolone.
- Long-term, intensive medical therapy targeting systemic disease suppression is the current best practice for PPG wound healing.
- The patient achieved complete PPG resolution within six months under specialized enterostomal/wound care.
Implications:
- This case highlights the importance of specialized wound care in managing rare PPG cases.
- Effective PPG management requires a multidisciplinary approach, integrating dermatological and ostomy care expertise.
- Prompt and accurate diagnosis is crucial to prevent delayed healing and improve patient outcomes.
Related Concept Videos
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:29Staphylococcal Skin Infections
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:26Gastritis II: Pathophysiology