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gastric cancer. Laparoscopic distal gastrectomy was performed. The ports were positioned in a reverse trapezoid shape, as commonly practiced. The umbilical port was 12 mm in size. The port below the right hypochondrium was 5 mm in size, and the other three ports were 12 mm. The opera-tion time and bleeding volume were 175 min and 35 ml, respectively, and no intraoperative complica-tions occurred. Until postoperative day 5, only low-grade fever and prolonged inflammation were observed, but without specific clinical symptoms. 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. Computed tomography showed no postop-erative intra-abdominal events but fluid retention in the subcutaneous tissue of the port site (Figure 1). He was diagnosed with SSI; therefore, the umbil-ical, right, and left latero-abdominal port wounds were opened and drained, and a Penrose drain® was placed. After administering broad-spectrum antibiotics and continuing the lavage treatment, the wound condition worsened, blisters and erosions were formed around it, and some necrotic findings with ulcers were also observed (Figure 2). Further-more, the inflammatory reaction became even more severe in the laboratory test. The course did not match that of the typical postoperative SSI; therefore, we consulted with a dermatologist. The patient was diagnosed with PPG because of painful skin findings exacerbated by external stimuli and No postoperative intra-abdominal events but fluid retention in the subcutaneous tissue of the port site.522Figure 1 Computed tomography findingsthe absence of bacteria in the culture test. Skin biopsy also showed a high degree of neutrophil infiltration from the epidermis to the dermis and multilocular cysts, consistent with PG (Figure 3). The treatment with oral prednisolone of 50 mg/day was started, which significantly improved skin and inflammatory findings (Figure 4, Figure 5a, 5b). Written informed consent was obtained from the patient for publication of this case report and any accompanying images.We managed a rare case of PPG occurring in a port wound after laparoscopic gastrectomy and required differentiation from SSI. Although the incidence of PPG is rare, most reports of PPG to date have come from dermatologists. Although very infrequent, it is one of the diseases that general surgeons should anticipate in differenti-ating atypical SSI. PG is a neutrophilic dermatosis typically presenting as a small pustule, surrounded by a halo of inflam-mation that rapidly becomes painful ulceration with undermined wound edges and violaceous borders4, 5). The cause of PG remains unknown, and its incidence is approximately 3-10 per million per Figure 2 Skin findings on the sixth postoperative day after drainage treatmentBlisters and erosions were formed around it, and some necrotic findings with ulcers were also observed.Discussion

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