A rare and potentially fatal complication of amoebiasis: acute fulminant necrotizing amoebic colitis

Abstract

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.A 65-year old male was admitted to surgical casualty with symptoms and signs of acute intestinal obstruction. He has been a toddy drinker for more than twenty years. Distended small and large bowel shadows were noted on the supine abdominal x-ray and inflammatory markers were elevated in blood. He underwent emergency laparotomy; descending colon and proximal part of sigmoid colon were found to be necrotic, with multiple perforations and a loculated abscess in the left paracolic gutter. The necrotic bowel loops were resected and the viable distal sigmoid colon was closed and an end colostomy was created.Macroscopically, specimen consisted of pieces of large bowel, measuring up to 15 cm in length and 6 cm in diameter, with patchy areas of full-thickness soft, white necrosis of the wall, ulcers with necrotic material adherent to their bases and large perforations (Figure 1). The ulcers were typically flask shaped, with a narrow neck and broad, undermined base. Microscopically, the affected bowel wall showed ischaemic necrosis with a mixed inflammatory cell infiltrate and small clusters of dispersed amoebic trophozoites (Figure 2 and 3). Periodic Acid Schiff staining was positive. The necrosis was transmural in the areas of perforation, and amoebic trophozoites were also seen within the lumen of blood vessels.

Acute fulminant necrotizing amebic colitis in a pediatric patient: a rare complication of amebiasis with high mortality—a case report

“…To our knowledge, there has been one other case of acute fulminant necrotizing amebic colitis reported in Sri Lanka from a 65-year-old male patient [13]. This case was from Jaffna, Northern Province.…”

Metronidazole for Amoebiasis: A tale of more than half a century

“…Fulminant colitis which present with severe abdominal pain and high fever is a very rare complication. Other occasional presentations include toxic megacolon, acute fulminant necrotizing amoebic colitis and an amoeboma presenting as a tender mass in the abdomen (7,8).…”

Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem

“…Generally, simultaneous colonic infection is seen in 50% of patients, presenting with ulcers commonly near the ileocecal valve and cecum [13]. Other complications include acute fulminant necrotizing amoebic colitis, toxic megacolon, toxic myocarditis, right iliac fossa mass, and acute appendicitis [47,[79][80][81][82]. Recent work also suggests increased co-infection rates of entamoeba with concomitant pulmonary tuberculosis [83], as well as a greater prevalence of rates of infection in patients with inflammatory bowel disease (Crohn's disease or ulcerative colitis), compared with the general population [84].…”