case acutenecrotizing coitis due to ameba

7/31/2019 case acutenecrotizing coitis due to ameba

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A Patient with

Colon Perforation due to Amebiasis:

A Rare and Fatal Complication

Putu Niken, Herry Purbayu, Ummi Maimu

nah, Ulfa Kholili, Iswan A Nusi,

Poernomo Boedi S, Titong Sugihartono, Budi Widodo, Nizam Oesman,

Pangestu Adi, Hernomo O. Kusumobroto

Case Report

Division of Gastroenterology and Hepatology

Department of Internal Medicineirlangga University School of Medicine -Dr Soetomo Teaching Hospital


2/11

Amebiasisinfection Entameba histolytica

World problem 10%worlds population100.000 deaths / year worldwide

Clinically amebic colitis is vaque, couldwrongly dx as IBDdelayedantiamebic, severe complication, death

Acute colitis with intestinal perforation is rare,less than 0.5 %, with mortality rate more than

40%

Introduction

(Stanley, 2001; Haque, 2003; Rees, 2010)


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Physical Examination and Laboratory Peritonitis

Manifestation Px

Physical examination

missing bowel sound

abdominal wall rigidity or

guarding missing liver dullness

Laboratory examination

Leukocytosis, electrolyteabnormality

X-ray

free gas visible in abdominal

cavity

(Doherty, 2005;Flasar, 2006)


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Assesment:

peritonitis due to perforation of the

intestine

exploratory laparotomymultiple perforation

caecum, colon ascenden, transversum, &

descenden

Subtotal colectomy, ileostomy, and Hartmann

procedure


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Progress Report

.

HPA: amebiasis colon withulceration and perforation.

Given Metronidazole 3x500mg iv

(12 days) improved &discharge


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COLONOSCOPY

No complaints

Stool: ery 5-10, leuco 5-10, amebic trophozoite +cyst +

Serameba (+) titre >1/32The asssment amebic

Tx: metronidazole 3x500 mg

10 months later


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DISCUSSION

stool

cysts or motile trophozoites in stool specimen. detection in stool ofE. histolytica specific antigen or DNA

serum

Antiamebic antibodies detected with IHA

sensitivity 70%

patology

presence of amebae in classic flaskshaped

lesions

p

atie

nt

(Haque, 2003; Soomro, 2009)


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clinical consideration

clinical picture is vague could wronglydiagnosed IBD due to similar clinical findings

Suspected IBD should investigate for amebiasisserologically and stool examination avoid disastrouseffects of steroids and immunosupressant in amebiasis

Px wrongly assesed IBD due to diarrhea with bloody stool,

abdominal cramps and fever in other health facility

(Gupta, 2009; Rees, 2010)


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treatment

Primary total resection treatment of choice.

Treatment of amebic colitis metronidazole 500 mgorally or iv 3x/ day for 710 days or 3550 mg/kg/day

tid for 7

10 days. Short term tx parasitic cure rate 80%.

Long term tx 10 -12 months 100% parasitic cure.

Gupta, 2009; Rees, 2010


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references

Gupta SS, Singh O, Shukla S, Mathur KR (2009) Acute FulminantNecrotizing Amebic Colitis: a rare and fatal complication of amebiasis: a case

report. Cases J 2: 655-668

Haque R, Huston CD, Huges M (2003) Currents concepts amebiasis. N Engl J

Med 348: 1558- 1564

Rees SL (2010) Amebiasis and infection with free- living amebas In: Fauci A ,

Braunwald E, Kasper DL, Hauser SL, Longo DL, eds. Harrisons

Gastroenterology and Hepatology. 17th edition. New York: McGraw-Hill 298-

303

Stanley SL (2001) Pathophysiology of amoebiasis. Trends in Parasitology 17:280 -284

Soomro AA, Badwi JA (2009) Serodiagnosis of Amebiasis by Indirect

Haemagglutination Test. Med Channel15: 72-7

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case acutenecrotizing coitis due to ameba

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