A Case Report of Fulminant Amebic Colitis

We experienced a 72-year-old man with fulminant amebic colitis. He was transferred to our Critical Care Center because of panperitonitis and was operated on immediately. The diagnosis was perforation of gangrenous appendicitis. Four days later, severe abdominal pain developed again. Perforation of the right transverse colon was found, and right hemicolectomy was performed. Several days later, trophozoites of Entamoeba histolytica were found in both the stools and mucus. Medication with metoronidazol was started, but the symptoms worsened progressively. A third operation was performed 12 days later. Multiple perforations of the left colon were found and left hemicolectomy was performed. After the operation, complications of DIC developed and the patient died about 6 weeks after admission. Recently amoebiasis has been increasing gradually in Japan. More than 130 cases were reported by the Ministry of Welfare in 1985. Amebic colitis is difficult to distinguish from other inflammatory bowel diseases. Fulminant amebic colitis in particular progresses so rapidly that its mortality rate is still very high. We consider that prompt diagnosis and treatment, especially appropriate surgical treatment, is very important.