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2)Department of Coloproctological Surgery, Juntendo University Hospital, Tokyo, Japan1)Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Tokyo, JapanSuguru YAMAUCHI1), Yuji ANDO2), Sanae KAJI1), Chen JUN1), Hiroki EGAWA1), Yutaro YOSHIMOTO1), Akira KUBOTA1), Yukinori YUBE1), Hajime ORITA1), Tetsu FUKUNAGA1)Corresponding author: Suguru Yamauchi Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, JapanTEL: +81-3-3813-3111　FAX: +81-3-5802-1557　E-mail: s.yamauchi.gk@juntendo.ac.jp〔Received　Apr. 21, 2022〕〔Accepted　Jun. 9, 2022〕J-STAGE Advance published date: Aug. 15, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ22-0017-CRBackground: Postoperative pyoderma gangrenosum (PPG) is a rare inflammatory skin disease of unknown etiology characterized by blistering and ulcerative lesions in postoperative wounds. Untreated pyoderma gangrenosum (PG) is potentially life-threatening; therefore, immediate and appropriate treatment is essential. Although PPG and surgical site infection (SSI) present similar clinical findings, they should be differentiated because of their conflicting treatment modalities.Case presentation: An 82-year-old man with comorbidities of pulmonary tuberculosis, chronic obstructive pulmonary disease, and diabetes underwent laparoscopic gastrectomy for gastric cancer. On postoperative day 6, fever exceeding 39°C, port wound redness, and pain was observed. Laboratory tests revealed severe inflammatory reactions: white blood cell, 42,800/μL and C-reactive protein, 30.2 mg/mL. The patient was diagnosed with SSI and treatment with antibiotics and drainage was started; however, his general and wound conditions also worsened. Therefore, he was diagnosed with PG because painful skin findings were exacerbated by external stimuli and no significant bacteria were detected in the culture test. Treatment with oral prednisolone was started, which significantly improved his skin and inflammatory conditions.Conclusion: We managed a rare case of PPG that occurred in a port wound after laparoscopic gastrectomy. If atypical clinical findings of postoperative SSI are observed, general surgeons should recognize and consider PPG as a differential diagnosis.Key words: postoperative pyoderma gangrenosum, laparoscopic gastrectomy, surgical site infectionJuntendo Medical Journal2022. 68(5), 521-525Case ReportsPostoperative Pyoderma Gangrenosum in a Laparoscopic Gastrectomy Port Site: Pyoderma gangrenosum (PG) is an uncommon, rare ulcerative skin disease characterized by a rapidly enlarging necrotic ulceration with an under-mined border and surrounded by erythema1, 2). Untreated PG is potentially life-threatening; there-fore, immediate and appropriate treatment is essen-tial. Postoperative pyoderma gangrenosum (PPG) is also designed as postsurgical or pathergic PG and is closely associated with superficial granulo-521A Case Reportmatous pyoderma3). Although PPG and surgical site infection (SSI) presents similar clinical find-ings, they should be differentiated because of their conflicting treatment modalities.An 82-year-old man with comorbidities of pulmo-nary tuberculosis, chronic obstructive pulmonary disease, and diabetes underwent upper gastrointes-tinal endoscopy performed by close examination of the black stool and was, therefore, diagnosed with BackgroundCase presentation