Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children

Vuille‐dit‐Bille, Raphael N.; Berger, Christoph; Meuli, Martin; Grotzer, Michael A.

doi:10.1097/mph.0000000000000324

Cited by 9 publications

(18 citation statements)

References 10 publications

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“…Due to the high of mortality of the condition, reported as high as 54% in perineal lesions associated with bacteremia, 5 aggressive medical treatment with combination antibiotic therapy is warranted, 6 , 7 and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. 2 , 4 , 8 …”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 The perineum and the axillary region are the most common sites of infection, even though virtually any site can be affected. 4 Ecthyma Gangrenosum can be associated with Pseudomonas Aeruginosa bacteremia, in which case the condition can be fatal. 5 …”

mentioning

confidence: 99%

“… 1 , 2 Surgical treatment includes debridement and skin graft 2 ; colostomy is often necessary in deep perineal lesions. 4 …”

mentioning

confidence: 99%

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Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl

Persano

Pinzauti

Pancani

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl

Persano

Pinzauti

Pancani

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…Surgical treatment (incision and drainage) has been shown to improve the survival of patients with a perirectal abscess in a small case series [11]. Surgical approaches vary from a simple incision and drainage to a defunctioning colostomy [3,13,15,16,19,20,21]. However, surgical intervention can be limited by many factors, such as frailty, a bleeding tendency, and a high risk of a subsequent infection in leukemia patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia

Chang

Kuo²,

Tang³

et al. 2017

Acta Haematol

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Introduction: Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear. Methods: We retrospectively collected patient data in our institute from 2009 to 2012. Results: Two hundred ninety-two patients with AML were analyzed. In total, 1,051 chemotherapy sessions were administered. Twenty-three patients experienced perianal abscess. Patients with perianal abscess were younger than those without (44 vs. 60 years, p < 0.0001). Perianal abscess developed in various phases of treatment and in the stem cell transplantation period. Twelve recurrences developed in 6 patients. Patients with a prior perianal abscess have a 10-fold risk of developing a subsequent abscess following further chemotherapy. The microbiology profile revealed that most pathogens were derived from the intestinal tracts, which was similar to the findings of previous studies. The 28-day mortality was 14.3% and the direct cause of death was not perianal abscess in any case. Surgical interventions had no impact on recurrence or survival. Conclusion: In patients with AML, perianal abscess results from gastrointestinal tract pathogens. Many patients do not require surgical interventions. The mortality is low but recurrence is common following subsequent chemotherapies. Therefore, awareness of recurrence is important for the timely management of perianal abscess in AML.

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“…Contemporary construction of an ostomy is often temporary with an intent to protect a downstream anastomosis by keeping the area clean from stool passage [102,103]. The goal of creating a diverting ostomy is hence to reduce rates of clinically apparent colorectal anastomotic leakage and to decrease severe complications and reoperation rates [103][104][105][106]. However, diverting ostomies are associated with considerable morbidity, patient inconvenience, and hospital cost [107].…”

Section: Single Vs Double Layer Sutured Anastomosismentioning

confidence: 99%

Evidence according to Cochrane Systematic Reviews on Alterable Risk Factors for Anastomotic Leakage in Colorectal Surgery

Wallace

Schuepbach

Gaukel

et al. 2020

Gastroenterology Research and Practice

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Anastomotic leakage reflects a major problem in visceral surgery, leading to increased morbidity, mortality, and costs. This review is aimed at evaluating and summarizing risk factors for colorectal anastomotic leakage. A generalized discussion first introduces risk factors beginning with nonalterable factors. Focus is then brought to alterable impact factors on colorectal anastomoses, utilizing Cochrane systematic reviews assessed via systemic literature search of the Cochrane Central Register of Controlled Trials and Medline until May 2019. Seventeen meta-anaylses covering 20 factors were identified. Thereof, 7 factors were preoperative, 10 intraoperative, and 3 postoperative. Three factors significantly reduced the incidence of anastomotic leaks: high (versus low) surgeon’s operative volume (RR=0.68), stapled (versus handsewn) ileocolic anastomosis (RR=0.41), and a diverting ostomy in anterior resection for rectal carcinoma (RR=0.32). Discussion of all alterable factors is made in the setting of the pre-, intra-, and postoperative influencers, with the only significant preoperative risk modifier being a high colorectal volume surgeon and the only significant intraoperative factors being utilizing staples in ileocolic anastomoses and a diverting ostomy in rectal anastomoses. There were no measured postoperative alterable factors affecting anastomotic integrity.

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Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children

Cited by 9 publications

References 10 publications

Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl

Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl

Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia

Evidence according to Cochrane Systematic Reviews on Alterable Risk Factors for Anastomotic Leakage in Colorectal Surgery

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