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Management of peristomal pyoderma gangrenosum
Lisa S Poritz1, Marjorie A Lebo, Anne D Bobb
1Division of Colon and Rectal Surgery, The Milton S Hershey Medical Center, Hershey, PA 17033, USA.
Journal of the American College of Surgeons
|January 29, 2008
Summary
Peristomal pyoderma gangrenosum (PPG) is a challenging complication for inflammatory bowel disease (IBD) patients. Surgical stoma closure effectively resolved PPG in all cases, offering a better outcome than medical therapies.
Area of Science:
- Gastroenterology
- Dermatology
- Surgical Oncology
Background:
- Pyoderma gangrenosum (PG) affects 1-5% of inflammatory bowel disease (IBD) patients.
- Peristomal pyoderma gangrenosum (PPG) presents significant management challenges.
Purpose of the Study:
- To investigate the incidence and management outcomes of peristomal pyoderma gangrenosum (PPG) in patients with inflammatory bowel disease (IBD).
Main Methods:
- Retrospective chart review of IBD patients who developed PPG between 1997 and 2007.
- Analysis of patient demographics, IBD type, stoma characteristics, and treatment outcomes.
Main Results:
- Sixteen IBD patients developed PPG, with a mean onset of 18.4 months post-stoma creation.
- Active IBD was present in 12 patients at PPG onset.
- Stoma closure resolved PPG in all five patients who underwent the procedure.
- Medical therapies, including cyclosporine and infliximab, showed limited success rates.
Conclusions:
- Active IBD is associated with a higher incidence of PPG.
- Surgical stoma closure is the most effective treatment for resolving PPG.
- Medical management of PPG with current biologics yields suboptimal results, underscoring the importance of surgical intervention when feasible.
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