Hornez E, Monchal T, Ottomani S, Bourgouin S, Platel J-P, Fournier B, Thouard H
Service de chirurgie viscérale et vasculaire, hôpital d'instruction des armées Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France.
J Chir (Paris). 2009 Dec;146(6):576-8. doi: 10.1016/j.jchir.2009.10.014. Epub 2009 Nov 17.
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.
本研究报告了1例癌症结肠造口术后引流口处发生的坏疽性脓皮病。最初的临床表现提示腹腔内感染，但临床评估结果与实验室检查结果或CT扫描不符。40小时后，患者引流口处出现红紫色溃疡。诊断为坏疽性脓皮病并开始全身使用糖皮质激素治疗。接下来的两天内出现显著疗效，无需再次手术干预。坏疽性脓皮病是一种病因不明的溃疡性坏死性皮肤疾病。它通常与潜在疾病（主要是炎症性肠病）相关，且常发生在造口旁部位。手术部位出现的坏疽性脓皮病常被误诊为术后感染，并因不恰当地进行清创和伤口重新开放处理而加重病情。全身使用糖皮质激素可有效治疗坏疽性脓皮病。
