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Case to highlight a rare differential diagnosis of necrotising fasciitis in the presence of a stoma: peristomal pyoderma gangrenosum
  1. Cheryl Chong1,
  2. Prasad Palanisamy2 and
  3. Eugene Shen-Ann Yeo2
  1. 1Department of General Surgery, Sengkang General Hospital, Singapore
  2. 2Department of Colorectal Surgery, Singapore General Hospital, Singapore
  1. Correspondence to Dr Cheryl Chong; cheryl.chong.x.z{at}skh.com.sg

Abstract

Peristomal pyoderma gangrenosum (PPG) is a rare clinical entity, which can masquerade as the more common and lethal necrotising fasciitis. The authors present a case of PPG in a 65-year-old woman who underwent robotic abdominoperineal resection for low rectal carcinoma and returned 8 days postoperation for peristomal skin ulcerations and pain, accompanied by leucocytosis; thus, she was treated as per necrotising fasciitis and underwent surgical debridement. Thereafter, her wound continued to worsen despite conventional wound care with vacuum-assisted closure and demonstrated signs of pathergy. The case was referred to dermatology where a diagnosis of PPG was made. This case report presents a cautionary tale for fellow clinicians, highlights the diagnostic challenge, and presents an updated literature review on diagnosis and management of this unique condition.

  • inflammatory bowel disease
  • colon cancer
  • gastrointestinal surgery
  • dermatology
  • medical-surgical nursing

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Footnotes

  • Contributors CC, PP and ES-AY had equal contributions to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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