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A 31-year cold woman presented with acute non-bloody diarrhea and persistent abdominal pain days after she travelled to Bhutan and India. Her medical history was uneventful. The pain was initially only associated with bowel movements, later constant in the lower right abdomen.
Clinical examination showed diffuse lower abdominal tenderness but no peritonitis. A gynecologic examination was unremarkable without signs of adnexitis and the cervical swab showed no STDs. Laboratory investigations showed hypokalemia and inflammation.
An abdominal ultrasound, a confirmatory CT scan, und later an MRI, showed severe right sided colitis with typical signs of appendicitis and perityphlitic abscess. Conservative therapy with metronidazole and ceftriaxone was started. Surgery was delayed due to the massive intestinal inflammation und the risk of hemicolectomy and ileostomy thereafter. Due to the retrocoecal location, CT-controlled drainage was not feasible.
The stool analysis revealed entamoeba histolytica and coli. As the inflammation and pain decreased, we switched from ceftriaxone to co-amoxicillin. After 10 days of metronidazole, we switched to paromomycin for endoluminal decolonization. Appendectomy is planned.