Abstract Number: 123

A perplexing peristomal plaque: A case of peristomal intestinal metaplasia

J Davey, D. Day, V. Howard, S.D. Smith

Meeting: 2016 Dermcoll

Session Information

Date: -

Session Title: Poster Presentations

Session Time: -

Peristomal intestinal metaplasia (PIM) of ileostomies has been rarely reported. We present an 88 year old Asian- Caucasian female with a history of ulcerative colitis and 55 year ileostomypresents with a 5 year history of peris- tomal skin irritation worsening over 2 years after develop- ment of a peristomal hernia. There was associated appliance leakage and peristomal skin ulceration. She was initially seen in a specialised stoma clinic and treated with Kenacomb and Aquacel dressings and a new convex ost- omy bag. It did not resolve and was referred to a dermatol- ogist. On presentation a 5cmx4 cm eroded, granulomatous papulonodular friable plaque was noted from 2 O’clock to7 O’clock of the ileostomy mucosa-cutaneous junction extending infero-medially onto the abdomen. Two shave biopsies showed mild papillomatosis, hyperkeratosis, acute on chronic inflammation with focal erosions and colonic epithelial islands, mixed with squamous epithelium indi- cating PIM. The glandular epithelium showed mild reac- tive, non-dysplastic, non-malignant changes. Initial treatment with silver nitrate was unsuccessful. Subse- quently, electrocautery using setting 2.0 on a 40Watt high frequency was performed under local anaesthetic. The eroded plaque completely re-epithelialised. However, 4 months later some small recurrences were treated with5.0 setting electrocautery and have not recurred.

Bile salt exposure increases intestinal epithelial cell migra- tion after wounding1 and metaplastic tubular gland secre- tions destroy the epidermis. Electrocoagulation eliminates these, allowing re-epithelialisation2. Whilst potential malignant transformation has not been in PIM, peristomal over granulation with intestinal metaplasia may undergo malignant transformation. We therefore recommend patients with PIM be monitored for recurrence and suspi- cious lesions biopsied.