Monga N K, Sood S, Kaushik S P, Sachdeva H S, Sood K C, Datta D V
Am J Gastroenterol. 1976 Oct;66(4):366-73.
A total of 18 patients with amebic peritonitis were studied. Fourteen of these cases were due to rupture of amebic liver abscess into the peritoneum and the remaining cases were due to perforation of amebic colitis. No initial suspicion of amebic etiology was made in more than half of the cases. In the group of ruptured liver abscesses, nearly half of the patients showed right lower lung syndrome. The diagnosis in 13 of 14 cases of rupture of liver abscess was confirmed on aspiration. Patients with ruptured amebic liver abcess were of two types: 1. Diffuse type with diffuse signs, shorter duration of illness and poor prognosis. 2. Localized type with longer duration of illness, marked signs of peritonitis and better prognosis. Once the diagnosis of peritonitis was made, the management was surgical. Conservative treatment was tried only in cases with signs of localization. The mortality rate had been 33% in amebic liver abscess rupturing into the peritoneum and 75% in perforation of the intestine. A high index of suspicion of amebiasis in patients with an acute abdomen and institution of early treatment are recommended to help in reducing this mortality. Amebic liver abscess and amebic dysentery should be treated energetically to avoid this fatal complication and surgical intervention whenever indicated should not be delayed.
共对18例阿米巴性腹膜炎患者进行了研究。其中14例是由于阿米巴肝脓肿破裂进入腹腔，其余病例是由于阿米巴结肠炎穿孔。超过半数的病例最初未怀疑有阿米巴病因。在肝脓肿破裂组中，近半数患者出现右下肺综合征。14例肝脓肿破裂病例中有13例经穿刺确诊。阿米巴肝脓肿破裂患者有两种类型：1. 弥漫型，体征弥漫，病程较短，预后较差。2. 局限型，病程较长，有明显的腹膜炎体征，预后较好。一旦确诊为腹膜炎，治疗方法为手术治疗。仅对有局限体征的病例尝试保守治疗。阿米巴肝脓肿破裂进入腹腔的死亡率为33%，肠道穿孔的死亡率为75%。建议对急腹症患者高度怀疑阿米巴病并尽早进行治疗，以帮助降低死亡率。应积极治疗阿米巴肝脓肿和阿米巴痢疾，以避免这种致命并发症，如有指征，手术干预不应延迟。
