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Marion Ferguson RN, BSN, CWCN
Jenny Yang RN, BSN, CWOCN
Emily Burnett RN, MSN, CWOCN
Kimberly Friel RN, BSN, CWOCN
8700 Beverly Boulevard Los Angeles, CA 90048 Cedars-Sinai Medical Center
Management of Complicated Peristomal Pyoderma Gangrenosum: Case Study
Background/Purpose: Peristomal Pyoderma Gangrenosum (PPG) is an autoimmune, systemic inflammatory process with manifestations of painful ulcerations. Most commonly, ulcerations appear on lower extremities; in some instances peristomal skin can also be affected.
This case study describes a 74-year-old female, with Crohn’s Disease, admitted for diverting loop ileostomy to treat a vaginal fistula. At 7 days, post-discharge, presented to ostomy outpatient clinic with peristomal complication and admitted with peristomal pyoderma gangrenosum.
Approach: Recommended PPG local wound management implemented. Initial treatment consisted of bacteriostatic wound dressing, hypochlorous acid antimicrobial wound solution, hydrofiber, stomahesive powder, stomahesive wafer, and flat ostomy appliance to remove sources of pressure and friction.
Negative Pressure Wound Therapy (NPWT) initiated as the PPG dimensions and exudate increased.
Although convexity barriers and ostomy belts aren’t recommended, a flexible light convex standard barrier utilized to reduce painful, frequent dressing changes due to pouch leakage.
Results: Total stay for treatment of PPG was 51 days and 4 post-discharge ostomy outpatient clinic visits. NPWT was discontinued. At post-discharge, Pt and spouse able to independently manage with hydrofiber, stomahesive wafer dressing and light convex pouch with ostomy belt.
Conclusion:
Although convexity ostomy barriers and ostomy belts aren’t recommended, we found utilizing these interventions aided in our ultimate goal of maintaining patient’s comfort and promoting wound healing. Use of newer soft convex flexible barriers may not have same pressure related risks as the traditional, more rigid convexity models.