Grecu F, Bulgariu Teodora, Blanaru Oana, Dragomir C, Lunca Claudia, Stratan I, Manciuc Carmen, Luca V
Third Surgical Unit, St. Spiridon Hospital of Iasi.
Chirurgia (Bucur). 2006 Sep-Oct;101(5):539-42.
Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.
侵袭性消化阿米巴病是温带地区一种罕见的病理情况。这可能导致危及生命的并发症:全身性阿米巴病。一名55岁男性在一家三级转诊医院成功治愈全身性阿米巴病。诊断基于流行病学数据和溶组织内阿米巴滋养体的显微镜鉴定。首先给予杀阿米巴、抗生素及支持治疗。肠道阿米巴病的临床表现从痢疾综合征发展为坏死性肠炎。肠穿孔伴局限性腹膜炎后出现慢性肠瘘。阿米巴肝脓肿作为最常见的肠外并发症,同时被诊断并治疗。在全身性播散的情况下,泌尿生殖系统阿米巴病被视为并发症:任何其他部位都可能成为阿米巴脓肿的发病部位。多学科方法是治疗该患者的成功关键,包括抗寄生虫治疗和抗生素预防、重症监护及多次手术治疗。在非流行地区,消化阿米巴病和全身性并发症的诊断可能会延迟,导致疾病进入晚期且病情复杂。手术方法最有效地治疗了巨大的肝阿米巴脓肿和腹腔内积液。