Abstract:

Background: expansion of tourism business in countries of South and Southeast Asia, Africa, and South America led to the appearance of rare parasitic diseases in Russia, Europe, and the United Kingdom. In our country, more than 1.3 million patients with various parasitosis are officially registered annually, among which there is an increase in the incidence of intestinal protozoa.

Aim: was to show features of the diagnosis of acute manifestations of necrotic amebic colitis, which simulated severe intoxication with manifestation of clinics of acute surgical disease and intestinal bleeding

Material and methods: using the example of case report of a 70-year-old woman, the possibility of complex diagnostics using abdominal ultrasound, abdominal computed tomography, colonoscopy with biopsy of intestinal ulcers and parasitological research methods is shown. Results: detoxification, anti-inflammatory therapy in a surgical hospital and instrumental examination allowed us to objectively evaluate and conduct targeted therapy avoiding serious complications.

Discussion: primary lesions with acutely occurring both local and general body reactions lead to severe intoxication, which does not allow to exclude acute surgical pathology, and in some cases dictate the need for urgent surgical intervention.

Differential diagnosis of an amoeba with a colon cancer only on the basis of x-ray symptoms is almost impossible. Specific anti-ameba therapy leads to the disappearance of amoeba.

Conclusion: only on the basis of a complex of clinical and epidemiological data, ultrasound, CT, colonoscopy, histological analysis and parasitological methods of research, pathology can be correctly identified. 

References

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Abstract:

Currently, the combination of acute cholecystitis complicated by choledocholithiasis is quite common.

Aim: was to improve the efficiency of diagnosis of complicated forms of gallstone disease (acute cholecystitis complicated by choledocholithiasis).

Materials and methods: study included 118 patients with acute cholecystitis complicated by choledocholithiasis. The age of patients ranged from 16 to 92 years (mean age 61,5 ± 2,5 years). Women were 86(78.5%), men - 32 (21.5%). All patients underwent ultrasound examination of the abdominal cavity, hepatobiliary scintigraphy (HBSG), MRI-cholangiography (MRHG), endoscopic retrograde cholangiopancreatography (ERCP) and biochemical blood tests with determination of total bilirubin, amylase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and protein fractions.

Results: in the diagnosis of choledocholithiasis sensitivity of ultrasound was 86%; HBSG - 97% MRHG - 92%. Basing on these data of sensitivity of different diagnostic methods, we developed diagnostic algorithm of acute cholecystitis complicated by choledocholithiasis: US → HBSG (if inefficient US ir terms of visualization of the distal common bile duct) → MRHG (to clarify causes of focal disorders of transport of labeled bile, according to HBSG) → ERCP: endoscopic papillosphincterotomy (EPST) and lithoextraction (LE) (detected choledocholithiasis or lingering doubts in the diagnosis).

Conclusions: the use of the diagnostic algorithm for acute cholecystitis in many cases allows timely identification of choledocholithiasis, followed by the implementation of adequate endoscopic sanitation of biliary tract, before performing cholecystectomy . 

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