The Diagnosis of Traveler’s Diarrhea Disguises an Unusual Cause of Ileus: Perforated Appendicitis Infected With Enterococcus avium

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Abstract

Travelers visiting tropical countries may contract acute infectious diarrhea with an incidence rate of 20% to 60% during a 2-week stay. Classic symptoms are diarrhea, nausea, vomiting, abdominal pain, and fever. These unspecific symptoms could also be caused by other acute illnesses, for example, appendicitis.

A 32-year-old man presented himself to our medical emergency department complaining of severe abdominal pain. The patient had returned from a skiing trip to India. One week before admission, he had liquid nonbloody diarrhea that disappeared after oral antibiotic treatment with ciprofloxacin and tinidazole. Laboratory findings revealed elevated inflammation parameters, and abdominal computed tomography showed severe small-intestinal ileus. Open laparatomy showed a gangrenous perforated appendicitis infected with Enterococcus avium as source of the symptoms.

Herein, we report an unusual—and for the clinician—very instructive case of complicated appendicitis, infected with E. avium that was at first disguised by the diagnosis of traveler’s diarrhea.

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