A Case of Fulminant Amoebic Colitis with HIV Infection Successfully treated by Staged Operations

Ayako Endo, Kazunori Takeda, Youichi Narushima, Hiromune Shimamura, Hiroshi Oshio, Shin Teshima, Toshihiro Saito, Shu Kikuchi and Hiroyoshi Suzuki*

Department of Surgery and Department of Pathology and Laboratory Medicine*, National Hospital Organization Sendai Medical Center

We reported a case of fulminant amoebic colitis with HIV infection. A 44-year-old man with a history of amoebic colitis and liver abscess admitted for left lower abdominal pain and bloody diarrhea. Free air was detected in the abdominal cavity by CT examination. Colonoscopy showed multiple ulcers in the sigmoid colon and rectum. The patient also had a history of HIV infection, and CD4 on admission was markedly decreased. He underwent emergency laparotomy with Hartmann's procedure due to peritonitis with perforated colitis. We confirmed the presence of Entamoeba histolytica trophozoides by histopathological examination. Despite metoronidazole administration, the colostomy became necrotic, with necrotic tissue observed in the ascending colon two weeks after the first operation. We conducted subtotal colectomy and ileostomy due to gangrenous change in all layers of the residual colon observed after laparotomy. The postoperative course was good and he was discharged four months after the second operation. This case suggests that staged surgery with Hartmann's procedure and subtotal colectomy may be useful in treating emergency cases of fulminant amoebic colitis.

Key words
fulminant amoebic colitis, perforation, HIV

Reprint requests
Ayako Endo Department of Surgery, National Hospital Organization Sendai Medical Center
2-8-8 Miyagino, Miyagino-ku, Sendai, 983-8520 JAPAN

Accepted
May 27, 2009

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