Use of Silver-Impreganated Hydrofiber and Wall-Suction in the Treatment of Peristomal Pyoderma Gangrenosum

PURPOSE: To present a case study involving the use of silver-impreganated hydrofiber and wall-suction in the treatment of peristomal pyoderma gangrenosum. Rationale: 60 year old male suffering from Crohn's disease since his early teenage years. Had been in and out of the hospital for many years with complications from his disease, including multiple small and large bowel resections and revisions.  Unfortunatley the patient has been left with short-bowel syndrome and a very high-output ileostomy, treated with Parenteral Nutrition in the past, but most recently was able to sustain nutrition. His Crohn's disease is complicated by very longstanding steroid dependency, in turn, developing Diabetes (poorly controlled) and pseudo obstruction, treated with decompressing proximal jejunostomy and home TPN. Patient developed extensive peristomal ulcers surrounding his jejonostomy with nausea, increased weakness and malnutrition, at which time pateint agreed to be admitted to hospital for nutritional parenteral support. PROBLEM: Maintaining a poucing seal around the stoma that would heal the pyodermal ulcers and contain the effluent. MANAGEMENT: Utilized wound and ostomy products along with low wall suction to maintain a 7 day pouching seal and heal the pyoderma gangresosum. Products utilized were a silver-impregnated hydrofiber, barrier spray, stomahesive powder, stomahesive wafer, convex 2 pc. pouching system, appliance belts, pink tape, and low wall suction. CONCLUSION: Pyodermal lesions healed, patient was able to maintain pouching system independently without the need for wall suction and patient was discharged back to home environment. Patient returned to hospital for unrelated diagnoses and follow-up was conducted. Patient's peristomal skin remained healed and ulcers did not return.