Pyoderma gangrenosum, rare parietal complication after colorectal surgery

Area of Science:

• Dermatology
• Gastroenterology
• Oncology

Background:

• Pyoderma gangrenosum (PG) is a rare, chronic, destructive inflammatory skin disease.
• It is often idiopathic but can be associated with systemic conditions like inflammatory bowel disease and arthritis.
• Recent literature suggests PG can manifest after local trauma, particularly surgery.

Observation:

• A 73-year-old male with rectal adenocarcinoma developed postoperative skin lesions.
• Lesions appeared as well-demarcated, vegetative plaques with ulceration, necrosis, and purulent secretion at the surgical site.
• Histopathology confirmed rectal adenocarcinoma and, crucially, pyoderma gangrenosum in its ulcerative stage.

Findings:

• The patient presented with abdominal skin lesions exclusively at the surgical site following rectum amputation.
• Histopathological examination of the cutaneous specimen definitively diagnosed pyoderma gangrenosum.
• The patient demonstrated a significant clinical improvement with systemic steroid therapy.

Implications:

• This case underscores the importance of considering pyoderma gangrenosum in postoperative patients presenting with unusual ulcerative skin lesions.
• Early recognition and appropriate treatment, such as systemic steroids, are crucial for managing this condition.
• The findings contribute to understanding the association between surgical trauma and the onset of pyoderma gangrenosum.