ABSTRACT
El pioderma gangrenoso periestomal (PGP) es una enfermedad inflamatoria de la piel con evolución a úlcera dolorosa, muy poco frecuente, que rara vez se asocia con el carcinoma colorrectal.Su diagnóstico es diferencial puesto que puede confundirse con una infección de la piel, absceso, dermatitis de contacto, irritación periestomal o la extensión cutánea periestomal de una enfermedad inflamatoria intestinal (EII).Se presentan tres casos de pacientes intervenidos por carcinoma colorrectal con estoma intestinal, que desarrollaron PGP.Se elaboró un plan de cuidados y curas locales, empleando las taxonomías de la North American Nursing Diagnosis Association (NANDA), la clasificación de resultados de enfermería (NOC) y la clasificación de las intervenciones enfermeras (NIC).Los cuidados del estoma y la adecuación de dispositivos colectores se realizaron con suero fisiológico, pasta, polvos de ostomía y bolsa de dos piezas.Para el tratamiento local básico se utilizó suero fisiológico o la solución de lavado para la limpieza de herida, eosina acuosa (2%), alginato en fase exudativa y pomada con colagenasa en presencia de necrosis esfacelos.El tratamiento local específico (clobetasol propionato, tacrólimus o infiltración de triamcinolona acetónido) y sistémico (corticoterapia) se efectuó de forma secuencial tras el diagnóstico de PGP en función de la respuesta clínica a cada terapia.El primer caso se resolvió a los seis meses con buena respuesta a la infiltración local de triamcinolona. El segundo se recuperó a los 10 meses tras infiltración local con triamcinolona y prednisolona oral. El tercero no tuvo respuesta a los tratamientos locales ni a la corticoterapia sistémica, curándose después de la exéresis tumoral y metastásica con reubicación del estoma a los nueve meses.(AU)
Peristomal gangrenous pyoderma is an inflammatory skin disease with progression to painful ulcer, rare, and rarely associated with colorectal carcinoma.Its diagnosis is differential since it can be confused with skin infection, abscess, contact dermatitis, peristomal irritation or peristomal skin extension of an inflammatory bowel disease.We present three cases of patients operated for colorectal carcinoma with an intestinal stoma, who developed peristomal gangrenous pyoderma.A plan of local care and dressings was developed using the NANDA, NOC and NIC taxonomies.Stoma care and fitting of collecting devices were performed with saline solution, paste, ostomy powders and a two-piece bag.For the basic local treatment, physiological serum or washing solution was used for wound cleaning, aqueous eosin (2%), alginate in the exudative phase, and collagenase ointment in the presence of slough/necrosis.Specific local treatment (clobetasol propionate, tacrolimus, or triamcinolone acetonide infiltration) and systemic treatment (corticosteroid therapy) was given sequentially after the diagnosis of peristomal gangrenous pyoderma depending on the clinical response to each treatment.Case 1 resolved at six months with a good response to local triamcinolone infiltration. Case 2 resolved at 10 months after local infiltration with triamcinolone and oral prednisolone. Case 3 had no response to local treatments or systemic corticosteroid therapy, healing after tumour and metastatic excision with relocation of the stoma at nine months.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Inpatients , Physical Examination , Pyoderma Gangrenosum , Skin Diseases , Ulcer , Nursing Care , Colorectal NeoplasmsABSTRACT
Peristomal gangrenous pyoderma is an inflammatory skin disease with progression to painful ulcer, rare, and rarely associated with colorectal carcinoma. Its diagnosis is differential since it can be confused with skin infection, abscess, contact dermatitis, peristomal irritation or peristomal skin extension of an inflammatory bowel disease. We present three cases of patients operated for colorectal carcinoma with an intestinal stoma, who developed peristomal gangrenous pyoderma. A plan of local care and dressings was developed using the NANDA, NOC and NIC taxonomies. Stoma care and fitting of collecting devices were performed with saline solution, paste, ostomy powders and a two-piece bag. For the basic local treatment, physiological serum or washing solution was used for wound cleaning, aqueous eosin (2%), alginate in the exudative phase, and collagenase ointment in the presence of slough/necrosis. Specific local treatment (clobetasol propionate, tacrolimus, or triamcinolone acetonide infiltration) and systemic treatment (corticosteroid therapy) was given sequentially after the diagnosis of peristomal gangrenous pyoderma depending on the clinical response to each treatment. Case 1 resolved at six months with a good response to local triamcinolone infiltration. Case 2 resolved at 10 months after local infiltration with triamcinolone and oral prednisolone. Case 3 had no response to local treatments or systemic corticosteroid therapy, healing after tumour and metastatic excision with relocation of the stoma at nine months.
Subject(s)
Inflammatory Bowel Diseases , Pyoderma Gangrenosum , Surgical Stomas , Humans , Pyoderma Gangrenosum/drug therapy , Surgical Stomas/adverse effects , Tacrolimus , Wound HealingABSTRACT
No disponible
