2003, Number 3
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ABSTRACTObjective: To describe the clinical case of a patient with an amebic colon perforation and its surgical treatment.
Design: Description of the clinical case.
Setting: Third level health care hospital.
Description of the case: A woman of 18 years that came to the emergency ward of the hospital with an illness of 15 days of evolution, characterized by diarrhea with mucus and blood traces, diffuse abdominal pain of moderate intensity, intense cephalea, fever of 38°C and general malady, she had been treated with chloramphenicol before attending the General Hospital of Mexico. Six days before admittance, she presented abdominal distension and increase of the abdominal pain, paracetamol and dimethicone were added to the treatment, at the time of admittance she was dehydrated, presented vomit, generalized intense abdominal pain, abdominal distension, and was unable to canalize gases with positive rebound. The laboratory test revealed 3,300/mm3 leukocytes, simple abdominal X-rays revealed hydro-air levels in the small intestine and “unpolished glass” image in the pelvic inlet. Acute stomach syndrome was diagnosed. Laparotomy revealed multiple perforations in the cecum and ascending colon, terminal ileum with perforation. Right hemicolectomy was performed with terminal ileostomy and distal closure using Hartman’s pouch procedure. The surgical piece depicted mucosa from the cecum and ascending colon, with ulcers in “shirt button” aspect and multiple perforations. The histopathology study revealed numerous amebic trophozoites in the colon.
Conclusion: Amebic intestinal disease presents in four types: asymptomatic colonization, acute amebic colitis, fulminant colitis, and ameboma. Complications are catastrophic with 50% mortality. The diagnosis of amebic colitis must be considered within a wide spectrum of clinical symptoms, especially in patients living in endemic zones.
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