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The presented case illustrates some of the difficulties of diagnosis and treatment of cutaneous amebiasis. Initially, in spite of an adequate general examination, the hepatic amebic abscess was missed, resulting in perforation into the peritoneum. Had the abscess been discovered preoperatively and treated by closed aspiration and emetine, it is possible that all of the complications might not have developed. Berne,2 Ochsner and DeBakey,3 and other authors pointed out that closed aspiration and emetine administration reduce the mortality of hepatic amebic abscess to its lowest figures.
After laparotomy, in spite of the administration of a course of emetine together with massive doses of penicillin and other antibiotics, the surgical wound would not heal and a progressive, gangrenous ulcer developed. Even with a strong suspicion of amebiasis, repeated search did not demonstrate any amebae in the wound. The patient became gravely ill and the ulcer increased in size. The culture of nonhemolytic streptococci and hemolytic Staph. aureus from the ulcer and its general appearance made the resemblance to postoperative progressive bacterial synergistic gangrene striking enough so that treatment with activated zinc peroxide dressings was initiated. Under this attack the foulness due to bacterial organisms was greatly reduced and the endamoeba finally found. Both encysted and trophozoite forms were demonstrated. Finally, by a combination of repeated wound débridement, dekinization, irrigation of the wound with carbasone, and repeated emetine courses, the patient was cured.
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- The Etiology, Diagnosis, and Treatment of Amebiasis.Williams & Wilkins Company, Baltimore1944
- Diagnosis and Treatment of Amebic Abscess.Surg., Gynec. & Obst. 1942; 75: 235-238
- Amebic Hepatitis and Hepatic Abscess; Analysis of 181 Cases With Review of Literature.Surgery. 1943; 13: 460-612
Received: April 11, 1950
☆Reviewed in the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the author are the result of his own study and do not necessarily reflect the opinion or policy of the Veterans Administration.
© 1951 Published by Elsevier Inc.