A Case of Peristomal Pyoderma Gangrenosum after Restorative Proctocolectomy for Ulcerative Colitis

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The patient was a 28-year-old male. As the patient was refractory to medical therapy, he thereafter underwent total colectomy, ileal J-pouch-anal anastomosis, and ileostomy as the first-stage operation. As the patient had ileus resulting from the elimination disorder with the stoma at postoperative day (POD) 9, a 20 Fr balloon catheter was inserted and placed to the oral side of the ileostomy, which improved the symptoms of ileus. From POD 12, he had strong pain around the stoma and acute ulcers around the stoma and at the operative wound. He was diagnosed with pyoderma gangrenosum and started to receive prednisolone 30 mg/day for treatment. For ileus, he had a favorable course for a few days after the balloon was removed, but similar symptoms repeatedly recurred. However, as he had concurrent generalized peritonitis due to intestinal perforation at POD 57, he underwent stoma closure as an emergency surgery, following which the pyoderma gangrenosum was almost resolved. After the surgery, his course was uneventful including the operative wound. In case of acute peristomal ulcer with strong pain, peristomal pyoderma gangrenosum should be suspected after disproving infection, and early diagnosis and treatment are required.