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  • br Discussion This patient presented

    2019-05-14


    Discussion This patient presented with a rare case of ameboma and underwent a right hemicolectomy procedure. However, the patient did not survive the surgical intervention and post-operative period due to severe sepsis. The primary reason that treatment failed was due to delayed diagnosis and treatment. At the time of surgery, the patient manifested peritonitis and sepsis, which caused multiple-organ failure during the post-operative period. In addition, we did not begin to administer niclosamide such as metronidazole for amebona on a monthly basis, 3 times daily for 7–10 days, until the pathologic report confirmation. The poor condition of the patient was irreversible, and lead to her to mortality. Delayed admission to hospital was also the main reason leading to mortality in a previous report. Ameboma is an inflammatory mass which consists of granulation tissue and peripheral fibrosis, and may be confused with malignancy in the cecum and ascending colon. Typically, ameboma occurs in untreated or inadequately treated patients, with an incidence of about 1.5% out of all amebiasis patients. Ameboma are usually found in a solitary mass and vary in size. The common complications of ameboma are perforation, obstruction, intussusception, fistula, and appendicitis. There was no direct relationship between ameboma and NPC, but NPC with immunodeficiency is a risk factor for amebiasis. However, the invasive form of Entamoeba can also infect normal populations. In general, most patients with amebiasis just receive medical treatment, and surgical intervention is only indicated for cases with suspected bowel perforation, peritonitis, local abscess, obstruction, diagnosis uncertainty, toxic megacolon, or ameboma. The medical treatment for noninvasive infections is paromomycin. Nitroimidazoles, especially metronidazole, are given for invasive amebiasis. Approximately 90 percent of patients with amebiasis have a response to nitroimidazole therapy. In some cases of fulminant amebic colitis, it is necessary to add broad-spectrum antibiotics for intestinal bacteria spilling into the peritoneum. Overall, the surgical mortality of all amebiasis patients ranged from 32 to 83%. The surgical methods employed included resection with or without exteriorization, perileal antegrade colonic lavage, and wide drainage with fecal diversion without resection. However, another problem is that the preoperative diagnosis of ameboma was found to be as low as 13–50% in a previous study. Pathologic examination of colonoscopic biopsy is the only method to more reliably make the diagnosis of intestinal amebiasis. However, the necessary biopsy target area can be difficult to approach, or the condition of the patient may not be suitable. One less invasive method used to diagnose amebiasis is antibody measurements, even if the antibody may be available and positive for years. Another method is microscopic examination of a collected stool specimen. But that method is substantially less sensitive and cannot differentiate between the species of Entamoeba.
    Conflict of interest