A case of fulminant amebic colitis

Abstract

A 52-year-old woman was admitted to the hospital because of pain in the right flank. She was diagnosed as having acute right colonic diverticulitis and treated conservatively. But her condition did not improve with conservative treatment and she developed acute peritonitis. Emergent laparotomy was thus performed. The Cecum and ascending colon swelled up and changed in color to dark-red. We performed right hemi-colectomy. The resected specimen showed geographic ulcerative lesions, but there were no diverticula. After temporary improvement, she developed acute peritonitis again and went into septic shock on the 13th day after the laparotomy. Re-operation was performed, and we found the transverse and sigmoid colons swelled up and changed in color to dark-red like the last time. We resected the transverse and sigmoid colons. The resected specimen showed geographic ulcerative lesions and Entamoeba histolytica trophozoites were identified in this specimen. Amebic colitis was diagnosed and administration of metronidazole was started. After that, her condition improved immediately.
The diagnosis of amebic colitis is difficult. We should pay attention to E. histolytica infection in the differential diagnosis of refractory ulcerative colitis since it has been increasing in Japan recently.