Peristomal Herpes
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IMAGES IN SURGERY
Peristomal Herpes Sudip Kumar Ghosh 1
&
Adrija Ray 2
&
Ankit Goel 3
&
Subhabrata Das 4
Received: 16 September 2020 / Accepted: 23 September 2020 # Association of Surgeons of India 2020
Abstract Peristomal skin conditions are frequent complications of enteral diversion procedures. Among infectious etiologies, Herpes simplex is an uncommon cause of peristomal skin lesions. Here we present an image of peristomal herpes simplex lesions, remarkably limited just to the skin in apposition to the pouch aperture, in a patient with transverse colostomy done for irresectable carcinoma rectum. Keywords Herpes simplex . Stoma . Transverse colon diversion
We present a case of a 50-year old gentleman, with a colostomy, presenting with multiple nodules on the peristomal skin and local irritation. The patient was a known case of irresectable carcinoma rectum, treated by transverse colon diversion and chemoradiation (2 cycles chemotherapy and 24 doses of radiation). The lesions, which were preceded by pain, presented as a cluster of clear vesicles that developed over a period of 3–5 days (Fig. 1) and eventually converted into dry, crusty areas. Remarkably, the lesions were sharply limited only on the skin absolutely adjacent to the stoma, which was not in contact with the adhesive part of the base-plate of the stoma pouch. On the basis of characteristic lesions, the case was diagnosed as herpes zoster infection. The patient was
empirically administered tablet acyclovir 800 mg five times a day for 10 days. The lesions showed significant regression with complete resolution of local symptoms (Fig. 2). Various colorectal conditions necessitate surgical procedures for intestinal diversion. Although ostomies are created with an aim to improve quality of life, 20–70% of ostomates experience stoma-related complications [1] and 7–20% patients with colostomies experience peristomal skin complications [1]. In a study, 6% of study respondents reported infections around abdominal stoma [2]. Warmth and moisture of skin, intermittent soiling by urine or stool, in addition to immune-suppression, due to palliative cancer therapy, provide an ideal setting for microbial growth. Swabs of peristomal skin reveal a spectrum of fungal, bacterial, and viral infections.
* Adrija Ray [email protected] Sudip Kumar Ghosh [email protected] Ankit Goel [email protected] Subhabrata Das [email protected] 1
R.G.Kar Medical College, Kolkata, West Bengal, India
2
R G Kar Medical College and Hospital, Kolkata, India
3
Natural City, K block, 3D, 43, Shyamnagar Road, Kolkata 700055, India
4
Department of Surgery, R G Kar Medical College and Hospital, Kolkata, India Fig. 1 Peristomal herpes lesion
Indian J Surg Fig. 2 Recession of the lesion
Among infectious etiologies, fungi (Candida albicans) [3] have been reported as the most common agent of peristomal skin infection. Immunosuppressed persons are predisposed to zoster infection due to higher chances of reactivation of the virus. Peristomal zoster infections are
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