Perforation of the colon in unsuspected amebic colitis

Abstract

Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.

Investigation of Entamoeba histolytica and Mycobacterium spp. in biopsy specimens of patients with inflammatory bowel disease in Turkey

“…Eight of these patients were diagnosed as amoebic colitis only on histopathological evaluation of the colonic endoscopic biopsy (Pai, 2008). On the other hand, a negative biopsy does not always rule out amebiasis and repeated biopsies may be needed for the diagnosis (Mendonca et al, 1977). Multiple biopsies and PAS stain are sometimes useful in highlighting the cytoplasm of the trophozoites within the exuda and picking up the organism.…”

Endoscopic view of rectal amebiasis mimicking a carcinoma

“…In most cases, an initial diagnosis of ulcerative or Crohn's colitis is made and the final diagnosis is established only after surgery for colonic perforation or hepatic abscess [3]. The difficulty in establishing the diagnosis occasionally led to the patients being treated for inflammatory bowel disease and receiving potentially dangerous steroid therapy [5].…”

“…In contrast to tropical countries like Singapore, amebic colitis is rare in Western countries and the diagnosis is often not considered [3]. In most cases, an initial diagnosis of ulcerative or Crohn's colitis is made and the final diagnosis is established only after surgery for colonic perforation or hepatic abscess [3].…”

“…A quick way to make the diagnosis is by examining the stool for trophozoites and cysts but it may be negative. The indirect hemagglutination test (IHA) is usually positive in amebiasis and employed when stools are negative for amebiasis or when extraintestinal amebiasis is suspected [3]. Rectal biopsy is useful and accurate as it may reveal the presence of the parasites and at the same time exclude the possibility of a carcinoma [4].…”

Fatal intestinal amoebiasis

“…The clinical picture is vague and hence confusing. Usually it is wrongly diagnosed pre-operatively as fulminating ulcerative colitis or perforated appendix with peritonitis (Chen, Chen and Lin, 1971;Judy, 1974;Kenoyer et al, 1976;Mendonca, Vieta and Korditz, 1977;Solowiejczyk et al, 1973). Unless early anti-amoebic treatment is commenced and appropriate surgery undertaken, the mortality is very high.…”