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Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children
Raphael N Vuille-dit-Bille1, Christoph Berger, Martin Meuli
1*Department of Pediatric Surgery ‡Division of Infectious Diseases and Hospital Epidemiology §Division of Oncology †Children's Research Centre, University Children's Hospital of Zurich, Zurich, Switzerland.
Insights
Early protective colostomy can significantly alleviate pain and promote healing in immunocompromised children suffering from ecthyma gangrenosum, a severe perianal infection.
Area of Science:
- Pediatric Infectious Diseases
- Surgical Oncology
- Immunocompromised Host Management
Background:
- Ecthyma gangrenosum is a severe perianal infection in immunocompromised children, often associated with Pseudomonas aeruginosa sepsis.
- Standard treatments include antimicrobials, debridement, and skin grafting, but outcomes can be poor.
- Perianal involvement presents unique challenges due to wound proximity and potential for mutilation.
Background:
Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation.
Procedure:
We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain.
Results:
All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care.
Conclusions:
These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.
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