Gangrene, postoperative progressive L88.x
Synonym(s)
Cullen Gangrene; Postoperative progressive skin gangrene; Progressive gangrenous ulceration of the abdominal wall; skin gangrene postoperative progressive; ulceration of the abdominal wall progressive gangrenous
History This section has been translated automatically.
Cullen, 1924
Definition This section has been translated automatically.
Very rarely occurring after surgery or trauma, large, superficial necrosis of unclear cause, usually localized in the abdominal area.
Etiopathogenesis This section has been translated automatically.
Mostly after local trauma or post-operative, possibly bacterial mixed infection.
Manifestation This section has been translated automatically.
Possible at any age, androtrophy. Mostly in full health.
Localization This section has been translated automatically.
Preferably abdominal area (e.g. starting from an appendectomy or sectio wound).
Clinic This section has been translated automatically.
1-2 weeks after the operation inflammatory redness, blistery lifting of the epidermis, starting from the wound edges. Formation of an inexorably centrifugally expanding superficial necrosis, possibly eventually encompassing the entire surgical region. Temperature increase, circulatory instability.
Differential diagnosis This section has been translated automatically.
External therapy This section has been translated automatically.
For superficial weeping skin changes, moist compresses with antiseptic additives such as quinolinol (e.g. quinosol 1:1000) or R042, quinosol baths (1 g/l) or potassium permanganate baths. For deep necroses, wound cleansing, granulation promoting agents and sterile wound dressing. S.u. Wound treatment.
Internal therapy This section has been translated automatically.
Glucocorticoids p.o. in medium dosage like prednisolone (e.g. Decortin H) 60-100 mg/day, slow reduction over months. Glucocorticoid savings through additional administration of azathioprine (e.g. Imurek) 100 mg/day. Alternatively test with Ciclosporin A (e.g. Sandimmun) 2.5-5 mg/kg bw/day p.o. Cave! Regular, monthly laboratory checks, accompanied by antibiotic protection according to an antibiogram.
Progression/forecast This section has been translated automatically.
Healing with extensive scarring.
Literature This section has been translated automatically.
- Born S et al (2001) Postoperative pyoderma gangrenosum. Surgeon 72: 1043-1047
- Cullen TS (1924) A progressively enlarging ulcer of abdominal wall involving the skin and fat, following drainage of an abdominal abscess apparently of appendiceal origin. Surg Gynecol Obstet 38: 579-582
- Grunewald AM et al (1992) Familial occurrence of the postoperative gangrene Cullen. Dermatologist 43: 795-797
- Long CC et al (1992) Minimizing the risk of post-operative pyoderma gangrenosum. Br J Dermatol 127: 45-48
- Schofer H et al (2002) Successful treatment of postoperative pyoderma gangrenosum with cyclosporin. J Eur Acad Dermatol Venereol 16: 148-151