title: Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature.
abstract: BACKGROUND
  Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis.
  
  
  METHODS
  A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12.
  
  
  CONCLUSIONS
  The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995-2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis.
  
  
  CONCLUSIONS
  We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013.
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan. Electronic address: itoudaisuke5995@yahoo.co.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan.
authors.forename: Shojirou
authors.initials: S
authors.lastname: Hata
authors.affiliation: Department of Pathology, Showa General Hospital, Tokyo, Japan.
authors.forename: Shimizu
authors.initials: S
authors.lastname: Seiichiro
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Teruya
authors.affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Kaminishi
keywords: Acute appendicitis; Amebiasis; Metronidazole