A Case of Amebic Appendicitis with Abdominal Wall Necrosis, Intestinal Perforation, and Infectious Myocarditis after Surgery

Abstract

A 48-year-old woman visited a doctor with a chief complaint of fever and abdominal pain. She was diagnosed with acute appendicitis and referred to our hospital. Since the symptoms improved with conservative treatment but became worse again after the start of a meal, she underwent emergency surgery. A necrotic appendix that had disintegrated near the root with abscess formation was found. The ileum ruptured into the abscess cavity. Partial cecal resection, partial small bowel resection, and abscess drainage were performed. Extremely poor postoperative infection control resulted in abdominal wall necrosis, cecal perforation, and acute heart failure due to infectious myocarditis. Therefore, the patient was managed in the CCU. Since Entamoeba histolytica was detected in the drainage on postoperative day 20, metronidazole treatment was started. Since the inflammatory reaction improved rapidly with adequate infection control, the patient was discharged on postoperative day 99. Despite the difficult postoperative management of acute appendicitis, anti-amoebic therapy effectively saved the patient's life after the diagnosis of entamoebiasis. This case is reported in the context of the literature.