Mendonca H L, Vieta J O, Korelitz B I
Dis Colon Rectum. 1977 Mar;20(2):149-53. doi: 10.1007/BF02587334.
Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.
本文报告了两例阿米巴结肠炎导致结肠穿孔这一严重并发症的病例。第一例术前诊断为急性溃疡性结肠炎伴中毒性巨结肠，第二例诊断为并发急性胆囊炎的腹膜炎。两例均在术后才做出正确诊断。第一例患者在结肠切除术后并接受抗阿米巴治疗后康复，但第二例患者在术后早期死于感染性休克。阿米巴结肠炎在美国并不常见，很少会考虑到该诊断。大多数情况下，最初会诊断为溃疡性或肉芽肿性结肠炎，只有在因结肠穿孔或肝脓肿进行手术后才会认识到真正的诊断。建议对于腹泻患者应更频繁地考虑阿米巴结肠炎。在阿米巴结肠炎中，粪便虫卵和寄生虫检查往往呈阴性。间接血凝试验（IHA）在阿米巴病中通常呈阳性，对于怀疑患有阿米巴病且有血性腹泻或其他临床症状的患者，应尽早进行该检查。直肠活检也是一种有用的诊断方法，但在我们的一例病例中未能发现阿米巴原虫。最后，建议当暴发性阿米巴结肠炎经抗阿米巴治疗未得到缓解、即使在进行抗阿米巴治疗过程中仍发生腹膜炎以及对于结肠穿孔或中毒性巨结肠（即使尚未开始抗阿米巴治疗）时，应紧急进行手术。
