Amoebic Colitis presenting as Acute Appendicitis

Kenji Okumura, Chol Joo Lee¹⁾, Yoshihiro Endo, Hideaki Kurioka¹⁾, Yasuyuki Enoki²⁾, Youhei Hosokawa³⁾ and Tohru Tani

Department of Surgery, Shiga University of Medical Science
Department of Surgery¹⁾ and Department of Pathology²⁾, Kyoto First Red Cross Hospital
Department of Pathology, Oumi Hatiman City Public Hospital³⁾

We report a case of amoebic colitis presenting as acute appendicitis in a 25-year-old Japanese woman. The patient visited our hospital complaining of lower abdominal pain, vomiting, and fever after returning to Japan from a one-month trip to India. She had severe lower abdominal pain and a slight rebound tenderness, and her abdomen was slightly distended. A swollen appendix extending to her umbilicus was detected on an abdominal enhanced CT scan and ultrasonography. She was diagnosed as having appendicitis and underwent an appendectomy. The resected appendix was 8.5×2.5 cm in diameter, red, and swollen like a large sausage. Because her abdominal pain, diarrhea, white stools, and high fever persisted after the appendectomy, we performed further examiniations. Evident thickening of the ascending colon wall was seen on a CT scan, and disseminated round erosions with a white coat and deep ulcers on her rectum and ascending and sigmoid colon were detected during a colonoscopy. Trophozite amoeba was found in a biopsy of the mucosae from her colon and appendix. The patient was diagnosed as having colitis caused by amoebasis and was treated with metronidazole (2 g/day for 10 days). Her symptoms rapidly disappeared, and no further complications occurred. Appendicitis was first suspected in this case, and only after an appendectomy was completed did futher examiniation reveal amoebic colitis. Since the disease was caught at an early stage, the metronidazole treatment was successful and the patient had a good outcome. Amoebiasis should be considered when treating patients with symptoms resembling acute appendicitis or gastroenterocolitis if the patient has been abroad, especially those who have visited amebiasis-endemic areas.

Key words
appendicitis, amoebic colitis, sexually transmitted diseases

Reprint requests
Kenji Okumura Department of Surgery, Shiga University of Medical Science
Seta-tsukinowa-cho, Otsu, 520-2192 JAPAN

Accepted
February 22, 2006

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