Stuiver P C, Visser L G
Havenziekenhuis, afd. Tropische Geneeskunde, Rotterdam.
Ned Tijdschr Geneeskd. 1993 Nov 6;137(45):2328-31.
Amoeboma was diagnosed in three patients: a Bengal seaman aged 40 and two Dutch citizens who had lived in the tropics, a man aged 41 and a woman aged 56. The first-mentioned patient had a rectal tumour easily inspected by sigmoidoscopy; a biopsy sample contained Entamoeba histolytica. The faeces contained no cysts. The two other patients had coecal amoebomas. They had been operated elsewhere on suspicion of appendicitis and had been treated with metronidazole, which had failed to eliminate the amoebae. The faeces still contained cysts. One patient had trophozoites in a biopsy sample. The serum of all three patients contained anti-amoeba antibodies. Two patients were treated successfully with a combination of metronidazole (a tissue amoebicide) and diloxanide (a lumenal amoebicide). In one patient this combination failed, and emetine had to be substituted for the metronidazole, also because of an allergic reaction. Amoeboma of colon or rectum is one of the many manifestation forms of amoebiasis, but it is rare. While in amoebic colitis tissue necrosis (histolysis) is encountered almost exclusively, in amoeboma there is a violent inflammatory reaction with formation of a pseudotumour by granulation tissue, possibly due to secondary bacterial infection. Endoscopy and determination of circulating antibodies against the causative agent E. histolytica have by now improved the diagnosis so much that adequate treatment without surgical intervention is possible in principle. As with so many exotic diseases, a stay in the tropics is the key to the diagnosis.
一名40岁的孟加拉海员以及两名曾在热带地区生活过的荷兰公民，一名41岁男性和一名56岁女性。上述第一名患者有一个通过乙状结肠镜易于检查的直肠肿瘤；活检样本中含有溶组织内阿米巴。粪便中没有包囊。另外两名患者患有盲肠阿米巴瘤。他们曾因疑似阑尾炎在其他地方接受手术，并接受过甲硝唑治疗，但未能清除阿米巴。粪便中仍有包囊。一名患者的活检样本中有滋养体。所有三名患者的血清中都含有抗阿米巴抗体。两名患者通过甲硝唑（一种组织内杀阿米巴药）和地洛酰胺（一种肠腔内杀阿米巴药）联合治疗成功。在一名患者中，这种联合治疗失败了，由于过敏反应，不得不将甲硝唑换成依米丁。结肠或直肠阿米巴瘤是阿米巴病的多种表现形式之一，但很罕见。在阿米巴结肠炎中，几乎只出现组织坏死（组织溶解），而在阿米巴瘤中，会有剧烈的炎症反应，由肉芽组织形成假肿瘤，这可能是由于继发细菌感染所致。内镜检查和检测针对病原体溶组织内阿米巴的循环抗体目前已极大地改善了诊断，以至于原则上无需手术干预就可以进行充分治疗。与许多外来疾病一样，在热带地区停留是诊断的关键。
