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* = Presenting author

N023 Gangrenous pyoderma management by an inflammatory bowel disease nurses team

N. Ruiz1, C. Rivas2, R. Camargo*3, R. Bosch4, R. Carreño3, J. J. Daza2, G. Alcain3

1Hospital Virgen de La Victoria, Gastroenterology, Malaga, Spain, 2Hospital Virgen de la Victoria, Digestive surgery, Malaga, Spain, 3Hospital Virgen de la Victoria, gastroenterology, Malaga, Spain, 4Hospital Virgen de la Victoria, Dermatology, Malaga, Spain

Background

Peristomal pyoderma gangrenosum is one of the most serious complications that may arise after the completion of a stoma. It is estimated to represent about 15% of all forms of PG. Described by McGarity in 1984 in 3 patients with Crohn’s disease (CD), it is considered an exceptional complication.

A case of peristomal pyoderma gangrenosum is presented in a CD patient that underwent a colostomy because of severe perianal disease. The patient was managed on an outpatient basis by a multidisciplinary team, which led to clinical improvement without hospitalisation.

Methods

The study provides a description of the multidisciplinary approach that includes different interventions by an estoma therapist (ET) nurse, a specialist nurse in inflammatory bowel disease, gastroenterologist, dermatologist, and surgeon.

Results

The patient studied had Crohn’s disease since she was 14 years old. She had multiple previous surgeries and short bowel syndrome. A colostomy was performed in March 2014 because of an aggressive perianal disease. Three months later she presented a 3 cm ulcerated lesion with prominent violet edges. The diagnosis of PG was confirmed by a biopsy. Initial treatment was performed with a corticoid infiltration. Infliximab was suspended for repeated infections. We proceeded then to local cures, adequacy of collecting devices, and topical application of tacrolimus by the ET nurse, finally getting wound healing.

Conclusion

The multidisciplinary approach is essential in the management of gangrenous pyoderma. In our case, given the need to remove the anti-TNF drug because of side effects proceeded to a predominantly local management where nursing care was essential for tissue restoration and normalisation of the quality of life of the patient. The treatments used were local cures with saline solution wound washes and application of solution for washing (purified water, 0.1% Undecilenamidopropil betaine, 0.1% polyhexanide) for 10 minutes, topical tacrolimus 0.1%. Rings flat barrier 98 mm were used with paste to prevent leaks and friction in the ulcerated area and open bag 2 pieces belted opaque.