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[Pyoderma gangrenosum mimicking abdominal sepsis after colorectal surgery].

Abstract
This study reports a case of pyoderma gangrenosum arising at a drainage orifice after a colostomy for cancer. The initial clinical presentation suggested intra-abdominal sepsis but the clinical assessment did not fit with laboratory findings or the CT scan. Forty hours later, the patient developed a reddish-purple ulcer at the drainage orifice. A diagnosis of pyoderma gangrenosum was made and systemic corticosteroid therapy was started. A dramatic response occurred over the next two days, obviating the need for surgical re-intervention. Pyoderma gangrenosum is an ulcerating necrotizing skin disorder of unknown etiology. It usually arises in association with underlying disease (mainly inflammatory bowel disease) and often occurs in para-stomal sites. Pyoderma gangrenosum arising at surgical sites is often mistaken for a postoperative infection and treated inappropriately with debridement and reopening of the wound which only exacerbates the pathology. Pyoderma gangrenosum is effectively treated with systemic corticosteroids.
AuthorsE Hornez, T Monchal, S Ottomani, S Bourgouin, J-P Platel, B Fournier, H Thouard
JournalJournal de chirurgie (J Chir (Paris)) Vol. 146 Issue 6 Pg. 576-8 (Dec 2009) ISSN: 1773-0422 [Electronic] France
Vernacular TitlePyoderma gangrenosum sur un orifice de drainage, pris pour un sepsis abdominal après une chirurgie colorectale.
PMID19922934 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Glucocorticoids
Topics
  • Adenocarcinoma (surgery)
  • Colectomy (adverse effects, methods)
  • Colon, Descending (surgery)
  • Colonic Neoplasms (surgery)
  • Diagnosis, Differential
  • Glucocorticoids (therapeutic use)
  • Humans
  • Intestinal Obstruction (surgery)
  • Male
  • Middle Aged
  • Pyoderma Gangrenosum (diagnosis, drug therapy, etiology, surgery)
  • Rectum (surgery)
  • Reoperation
  • Sepsis (diagnosis)
  • Treatment Outcome
  • Wound Healing

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