Colocutaneous fistula secondary to amoebiasis

Abstract

a b s t r a c tHere we present an interesting and extremely rare case of a 66 year old male who developed a colocutaneous fistula secondary to amoebiasis. The patient presented with an acute history of right lower abdominal pain, weight loss and a palpable mass. A CT scan demonstrated a fluid filled cavity in the right iliac fossa consistent with an appendiceal abscess which was drained under radiological guidance. However, following drainage his symptoms remained requiring open surgical drainage, and a controlled caecostomy was performed due to a small caecal perforation. Despite appropriate conservative therapy he failed to progress, and developed localised sepsis in the right iliac fossa with a colocutaneous fistula, requiring a formal right hemicolectomy. The histological examination confirmed the presence of abundant trophozoites of Entamoeba histolytica.We highlight the fact that in the modern age of immigration and long distance travel, it will become increasingly likely that the so-called 'tropical' diseases will present throughout the world. This case also highlights the need to keep an open mind in cases that do not progress as expected, and to react accordingly to any unusual developments.

Amebic Acute Appendicitis: Systematic Review of 174 Cases

“…Two of the early studies reported results from barium swallow radiography [39, 40], which was later replaced by imaging analysis. Among the seven patients with findings reported from ultrasonography and/or computed tomography scanning, acute appendicitis was diagnosed in four, periappendicular abscess in two, and a right abdomen lower quadrant mass in one [1, 2, 8, 9, 17, 18, 25]. The final diagnoses for the overall patients included acute appendicitis (167/172, 97.0 %), of whom 6 % had complicated acute appendicitis, including a periappendicular abscess, periappendicular mass, and perforated appendicitis (Table 2).…”

“…Operative findings were reported for 153 patients (Table 3), which included 47 (30.7 %) cases of complicated acute appendicitis including perforated appendicitis ( n = 40) [7, 10, 14, 15, 19, 28, 33, 34, 38, 39], periappendicular abscess ( n = 3) [2, 25, 28], amebic mass ( n = 2) [7], and pericecal inflammation ( n = 1) [28]. One complicated case had no details reported [16].…”

“…Abdominal examination revealed rebound tenderness and guarding in all cases. Among the three patients reported to lack signs of peritonitis, one had a periappendicular abscess [2] and one had a right lower quadrant mass [25]. Interestingly, the third patient had slight abdominal pain and radiologically confirmed findings of acute appendicitis without any other clinical findings of the disease.…”

“…No restrictions were made on language, country, or journal. A total of 171 articles were retrieved for review, and 42 articles [1–42] were selected for inclusion in the analysis (Fig. 1).…”

Kolon perforasyonunda histomorfolojik tanı güçlükleri

“…Fakat dışkı mikroskopisinin sensivitesi %60'dan düşük ve spesifitesi %10-50 arasındadır. ELISA yöntemi ile değerlendirildiğinde dışkıda antijen tesbitinin spesifite ve sensitivitesi %95'in üzerindedir (11). Amibiazisde, kolonda 1-2 mm çapında küçük yüzeyel ülserler mukozada dağınık halde izlenir (9 (22).…”