A Case of Amebiasis Causing Necrosis of the Abdominal Wall and Intestinal Perforation after Surgery for Acute Appendicitis

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  • 急性虫垂炎の術後に腹壁壊死と腸管穿孔をきたした赤痢アメーバ感染の1例
  • 症例 急性虫垂炎の術後に腹壁壊死と腸管穿孔をきたした赤痢アメーバ感染の1例
  • ショウレイ キュウセイ チュウスイエン ノ ジュツゴ ニ フクヘキ エシ ト チョウカン センコウ オ キタシタ セキリ アメーバ カンセン ノ 1レイ

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Abstract

A 53-year-old woman consulted us for fever and lower abdominal pain, and was diagnosed as having acute appendicitis with an intra-abdominal abscess. Appendectomy was performed, with drainage of the abscess. However, since purulent discharge was observed from the drain postoperatively, a residual abscess was diagnosed, which was irrigated and drained on day 10 of hospitalization. However, the infection progressed and the subcutaneous abscess caused necrosis of the abdominal wall and penetration of the sigmoid colon. Sigmoidectomy and ileocecal resection were performed on day 31 of hospitalization. Antibiotics were administered and the local irrigation was continued. However, infection control was extremely difficult. Exposed by a defect in the abdominal wall, the ileocolic anastomosis was found to be perforated. The perforation was closed on day 59 of hospitalization, and the abdominal wall was debrided. Histopathologic examination of the removed tissue revealed Entamoeba histolytica, which led to the diagnosis of amebiasis. With administration of metronidazole, the infection resolved and granulation tissue formed, leading to closure of the abdominal wall. The patient was discharged on day 189 of hospitalization. We have reported a rare case of amebiasis developing after surgery for appendicitis.<BR>Infection control was difficult, however, the patient responded well once the infection was definitively diagnosed.

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