Concomitant manifestation of pyoderma gangrenosum and colorectal carcinoma.

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin and is commonly associated with inflammatory bowel disease, arthritis or lymphoproliferative disorders. Only sporadic cases of pyoderma gangrenosum in combination with malignant disease of the gastrointestinal tract have been reported until now. We report on a 53-year-old patient who suffered injury to the right scapula while gardening. Initially, the patient had only a superficial wound of the upper skin but in the subsequent weeks the lesion developed into an ulcerative defect and pyoderma gangrenosum was diagnosed. Laboratory test results, ultrasound of the abdomen and computed tomography of the chest and abdomen were normal. Immunosuppressive therapy with prednisolone and azathioprine was initiated. Four months later the patient was admitted to the gastroenterology department for further examination because of chronic fatigue, subfebrile temperature and a positive fecal occult blood test. Colonoscopy showed a semicircular carcinoma of the sigmoid colon measuring 3-4 cm. A left-sided hemicolectomy was performed. Microscopic examination revealed an adenocarcinoma (T3, N2, G3) and consequently the patient was given adjuvant chemotherapy. Nine months later the patient was asymptomatic and the pyoderma gangrenosum had recovered. Pyoderma gangrenosum is not only associated with inflammatory bowel disease or lymphoproliferative disorders. This case report demonstrates that colorectal carcinoma must also be considered as a possible differential diagnosis. The fast and complete remission of pyoderma gangrenosum following surgical treatment of colorectal carcinoma emphasizes a causal relationship.

Long-term outcome following placement of percutaneous endoscopic gastrostomy in younger and older patients.

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) is the method of choice in maintaining enteral nutrition in patients with swallowing and nutritional disorders of different etiology. The aim of this study was to assess the long-term outcome of patients following placement of a PEG. MATERIAL AND METHODS: All patients who received a PEG between October 1999 and September 2000 were included in this prospective study. Long-term function, replacement or removal of the PEG, complications and survival of the patients were analyzed in group A (younger than 75 years) and group B (75 years or older). RESULTS: The indications for PEG placement in group A (54 patients, mean age 54.5 years) were neurological (66.7%) and malignant (31.5%) disorders, whereas in group B (40 patients, mean age 81 years) the indications were predominantly neurological diseases (87.5%). The majority of patients (91 of 94 patients; 96.8%) could be followed long term or until death. In group A, 46 patients (85.2%) had uncomplicated long-term function of their PEG and interventions were necessary in only 8 patients. Removal of the PEG was possible during the course in 17 patients (31.5%). In group B, uncomplicated long-term function was observed in 34 patients (85%) and interventions were required in only 6 patients. Removal of the PEG was not possible in group B. Survival rates for 1-, 2- and 5 years in group A were 73.9%, 61.8% and 43.9%, respectively, and in group B 41.4%, 31.9% and 15.9%, respectively; the difference was statistically significant (p=0.002). CONCLUSIONS: Excellent long-term function of PEG was seen in this study of 94 consecutive patients, and interventions were necessary only in a minority of patients. The prognosis for older patients was worse; however, the 2-year survival rate of 32% justified the PEG insertion.