Recurrent fulminant amoebic colitis with perforation treated twice successfully by surgery—a case report

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 71; no. 3; pp. 747 - 751
• Main Authors: TORIGUCHI, Kan, HASHI, Hiroyuki, NAKASHIMA, Yasuo, HANAFUSA, Tetsuji
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2010
• Subjects: amoebic colitis; fulminant
• DOI: 10.3919/jjsa.71.747
• ISSN: 1345-2843

A 76-year-old male developed diarrhea, hematochezia, and nausea. On the second hospital day, he developed a marked change in his abdominal pain. On CT scan, free intraperitoneal air and massive ascites was noted. The patient had a laparotomy. Perforations were visualized at the cecum and the transverse colon. A right hemicolectomy and an ileostomy were done. The cause of the perforation could not be determined. On day 4, the patient developed intense abdominal pain. On CT, re-perforation of the colon was found ; perforations were visualized at the transverse colon and the lower rectum. The patient had a total colectomy with a subtotal proctectomy. On day 10 after the first operation, amoebic trophozoites were identified in the colonic mucosa specimen. Metronidazole was administered. The patient's general condition improved, and he was discharged. The number of cases of Entamoeba histolytica is increasing in Japan. Early diagnosis followed by early chemotherapy is the key to successfully treating this disease.