Online edition:ISSN 2758-089X

A case of fulminant amebic colitis that could be saved

An 80-year-old man was admitted to a neighboring hospital with severe diarrhea and bloody stools. He did not have a remarkable medical history, was not homosexual, and had not traveled outside the country for several years. Colonoscopy was performed on the day of admission and revealed multiple ulcerations with edematous mucosa throughout the colorectum. Histopathological findings of biopsy specimen could not identify the reason for the inflamed colon. On postadmission day 6, the patient developed severe abdominal pain and underwent an emergent surgery for pan-peritonitis due to bowel perforation. The laparotomy revealed glossy fecal pan-peritonitis with perforation of the sigmoid colon; necrosis was observed through the entire length of the colon. The colonic tissue was extremely fragile and exhibited a blotting paper-like appearance. Total colectomy, sigmoid mucous fistula, ileostomy, and intraperitoneal drainage were performed. On postadmission day 12, histopathological findings of resected specimen raised the suspicion of amebic dysentery, and we accordingly treated him with metronidazole (2,250 mg/day) administered orally. Abdominal CT images taken on days 12 and 20 postadmission showed multiple liver abscesses, which improved following metronidazole administration. Metronidazole was discontinued 14 days after initiation as the patient’s general condition improved. His condition remained stable thereafter, and he was transferred two months after admission. doi:10.11482/KMJ-E43(1)13 (Accepted on February 23, 2017)

Ueno D, et al