Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
J Infect Dev Ctries. 2022 Apr 30;16(4):717-725. doi: 10.3855/jidc.15419.
Intestinal amoebiasis is a parasitic infection caused by Entamoeba histolytica. It is commonly found in developing countries with poor hygiene. A rare, life-threatening complication of amoebiasis is fulminant necrotizing amoebic colitis (FulNAC). We report a 59-year-old male with acute lower right abdominal pain. Before coming to our institution, he was diagnosed with acute appendicitis. Extensive necrosis near the caecum involving the appendix and colon was observed intraoperatively. The patient underwent a right hemicolectomy, followed by an ileostomy and colostomy. Histopathologic examination confirmed the diagnosis of FulNAC. After the surgery, the patient was transferred to the high care unit and treated with metronidazole after histopathologic findings confirmed the etiology. The patient showed excellent response to the antibiotic prescribed, and the symptoms subsided. He was discharged from the hospital on day nine. Additionally, we reviewed fifty-one existing case reports on invasive intestinal amoebiasis worldwide, confirmed by histopathological examination following their preoperative diagnosis, surgery, pharmacology treatment, and outcomes. The learning point of this case is that intestinal amoebiasis should be considered a differential diagnosis for patients around fifty years old with bowel symptoms and travel history or living in tight quarters. Blood tests, radiological examinations, and serological evaluations are valuable diagnostic modalities. Metronidazole should be given as early as possible, and health promotion is recommended to prevent this disease in the population.
肠阿米巴病是由溶组织内阿米巴引起的寄生虫感染。它通常在卫生条件差的发展中国家发现。阿米巴病的一种罕见的、危及生命的并发症是暴发性坏死性阿米巴结肠炎（FulNAC）。我们报告了一名 59 岁男性，他患有急性右下腹痛。在来我们医院之前，他被诊断为急性阑尾炎。术中观察到盲肠附近广泛的坏死，累及阑尾和结肠。患者接受了右半结肠切除术，随后进行了回肠造口术和结肠造口术。组织病理学检查证实了 FulNAC 的诊断。手术后，患者被转至重症监护病房，并在组织病理学结果证实病因后接受甲硝唑治疗。患者对所开抗生素的反应良好，症状缓解。他在第九天出院。此外，我们回顾了全球 51 例经组织病理学检查证实的侵袭性肠阿米巴病的现有病例报告，这些病例报告涉及术前诊断、手术、药理学治疗和结果。这个病例的学习点是，肠阿米巴病应该被认为是五十岁左右有肠道症状和旅行史或生活在拥挤环境中的患者的鉴别诊断。血液检查、影像学检查和血清学评估是有价值的诊断方法。甲硝唑应尽早给予，应提倡健康促进以预防该人群的这种疾病。
