Parastomal small bowel evisceration as a result of parastomal pyoderma gangrenosum in a patient with Crohn's disease

Pyoderma gangrenosum (PG) is an idiopathic neutrophilic dermatosis that is associated with a wide variety of disorders, including inflammatory bowel disease, visceral malignancies, and hepatobiliary disorders to name a few.1, 2 PG is classified by clinical characteristics; there are four main types: 1) ulcerative, 2) pustular, 3) bullous, and 4) vegetative.1, 2 Although each variant demonstrates a unique clinical course and unique histopathologic features, they may be described as skin lesions that are single or multiple, may erupt on any cutaneous site, and are extremely painful. The etiology of parastomal PG is unknown, but may be secondary to inflammation caused by stoma appliance adhesive or surgical trauma as mentioned above.1 Histologically, there is some debate regarding the natural history of PG.