Conservative management of paraileostomy ulcers in patients with Crohn's disease

Paraileostomy ulcers (PSU) are uncommon after construction of an ileostomy and are difficult to manage. Seventeen patients with Crohn's disease developed 28 parastomal ulcers at least 1.5 cm in diameter from two weeks to seven years after ileostomy construction (mean 45.6 weeks, median 8 weeks). Some patients had multiple episodes of parastomal ulceration. The etiology and clinical features of PSU are discussed. Conservative management included debridement, curettage, unroofing of the ulcer complex, pouching of the stoma with Telfa strips placed in the ulcer base and a conventional appliance or a Perry Model #51 device. Most of the ulcers healed between two and 32 weeks (mean 12.7 weeks, median 8 weeks). In the six patients in whom the ulcers did not heal, Crohn's disease or another ileostomy complication necessitated ileostomy relocation. This conservative management allowed most patients to be treated on an outpatient basis, carrying out their daily tasks and delaying or obviating the need for ileostomy relocations. When required, relocations were done electively.