Fulminating amoebic colitis: A clinical evaluation

Abstract

Eleven cases of fulminating amoebic colits seen in 5 years are reported. Only people of low socioeconomic status were affected and most were in good health previously. The disease appeared to follow a fulminant course from the onset and was rarely a secondary phenomenon superimposing on the chronic amoebic dysentery. The diagnosis was difficult due to severe systemic manifestations and the periodic absence of Entamoeba histolytica in the stool. The development of colonic necrosis was often masked by the severe preexisting local signs and perforation could occur in spite of adequate anti‐amoebic therapy. Mortality was related to late diagnosis, delayed recognition of irreversible colonic necrosis and inadequate surgical treatment. To reduce the present 55 per cent mortality further it is proposed that, in an endemic area, early specific antiamoebic therapy is justified in severe and undiagnosed colitis. Even under specific anti‐amoebic treatment the patient with severe amoebic colitis remains a potential surgical candidate. Surgery is indicated when the patient continues to deteriorate in spite of the therapy, when there is an acute episode which signifies perforation, or when severe diarrhoea, toxaemia and abdominal tenderness persist after a full course of specific anti‐amoebic therapy. Primary total resection of the diseased colon is the treatment of choice.

Acute fulminant necrotizing amoebic colitis: a rare and fatal complication of amoebiasis: a case report

“…Early diagnosis and surgical treatment significantly decrease mortality [8,9]. It has been stated that conservative surgery has no place in the management of acute FAC, and primary total resection is the treatment of choice [19]. Because there is a high risk of suture breakdown in tissue containing amoebae; a staged operation in the form of exteriorization of the proximal and distal transected ends, and bowel reconstruction 3-6 months later, is highly recommended for FNAC [20].…”

“…Because there is a high risk of suture breakdown in tissue containing amoebae; a staged operation in the form of exteriorization of the proximal and distal transected ends, and bowel reconstruction 3-6 months later, is highly recommended for FNAC [20]. Also, in endemic areas, patients with severe and undiagnosed colitis should be treated presumptively with specific antiamoebic therapy until a diagnosis of amoebic colitis can be excluded [8,9,19].…”

Acute fulminant necrotizing amoebic colitis: a rare and fatal complication of amoebiasis: a case report

“…Early diagnosis and surgical treatment significantly decrease mortality [8,9]. It has been stated that conservative surgery has no place in the management of acute FAC, and primary total resection is the treatment of choice [19]. Because there is a high risk of suture breakdown in tissue containing amoebae; a staged operation in the form of exteriorization of the proximal and distal transected ends, and bowel reconstruction 3-6 months later, is highly recommended for FNAC [20].…”

“…Because there is a high risk of suture breakdown in tissue containing amoebae; a staged operation in the form of exteriorization of the proximal and distal transected ends, and bowel reconstruction 3-6 months later, is highly recommended for FNAC [20]. Also, in endemic areas, patients with severe and undiagnosed colitis should be treated presumptively with specific antiamoebic therapy until a diagnosis of amoebic colitis can be excluded [8,9,19]. …”

Amebiasis

“…30 Additional studies in the literature support a mortality rate of 50% to 100% (Table 1). 1,[30][31][32][33][34][35][36][37][38] Finally, fulminating colitis has been observed with increasing frequency in patients suffering from malnutrition, diabetes, and other chronic illnesses. 31 The classic operative finding in a patient with fulminating colitis is an inflamed, extremely friable colon.…”