This case report describes a patient with colonic Crohn's disease and perianal disease. The patient experienced extensive and severe pyoderma gangrenosum after colectomy. Steroids and anti-inflammatory medication had no effect on pyoderma or the persistent perianal and rectal disease. All pyoderma lesions eventually healed after proctectomy and excision of perianal fistulae. The relevance and effect of surgically induced remission on medically resistant inflammatory bowel disease-associated pyoderma gangrenosum is highlighted.