PARASTOMAL PYODERMA-GANGRENOSUM IN INFLAMMATORY BOWEL-DISEASE

PURPOSE: Parastomal pyoderma gangrenosum is uncommon and its associati on with inflammatory bowel disease is unclear. This is a review of fiv e patients with parastomal pyoderma gangrenosum. METHODS: A retrospect ive review of five patients with ulcerative colitis (two patients) or Crohn's disease (three patients) who have been seen in one surgical un it was conducted. RESULTS: All patients were females and each presente d within nine months of abdominal surgery and stoma construction. All had active proctitis (n = 3) or perianal Crohn's disease (n = 2). Both patients with perianal Crohn's disease had a mild clinical course wit h healing of parastomal pyoderma gangrenosum when treated with steroid s with and without low-dose cyclosporin A. They both had curettage of the perineal wound as well. In the remaining three patients with activ e proctitis, the parastomal lesions failed to resolve despite high-dos e systemic steroids. By contrast, the parastomal pyoderma gangrenosum healed promptly in two of these patients following proctectomy for act ive proctitis. CONCLUSION: The variable clinical outcome of parastomal pyoderma gangrenosum may be related to the activity of the underlying inflammatory bowel disease or possibly to low-grade perineal sepsis.