Evolution of Surgical Treatment of Amebiasis-Associated Colon Perforation

Abstract

Perforation is the most frequent surgical complication of invasive amebiasis of the colon, occurring principally in masculine gender and in the fourth decade of life. Resection and stoma creation is the procedure of choice that can resolve the septic focus from the first surgical procedure, depending on the general status of the patient. However, morbidity and mortality are high, and there is a tendency for these to be lower on comparing initial cases with those with recently conducted surgical procedures.

Amoebic Colonic Perforation Presenting as Peritonitis in Emergency, Incidence and Outcome: Our Experience

“…Fulminant colitis, which is a known to be a variant of amoebic colitis, develops rapidly and presents with features of acute abdomen and loose stools. Various risk factors, including male gender, increased age, signs of peritonitis and abdominal pain, leukocytosis, electrolyte disturbances, and hypoalbuminemia, are associated with the de velopment of fulminant amoebic colitis in patients with invasive intestinal amoebiasis (4,5). In our study, associated liver abscess was seen in 36% cases, emphasing its coexistence, and it was noticed that these patients were more sick and developed more postoperative complications compared to those who presented only amoebic colonic perforation.…”

Colonic perforation with peritonitis in amoebiasis: A tropical disease with high mortality

“…2 In a nutshell, preoperative diagnosis is uncommon and ranges from 0% to 50% in various studies. 1,3,5 In our study, it was suspected in none of the patients probably because cases of amoebic colon perforation with their acute nature of presentation mimicked the more frequently encountered surgical emergencies such as ileal, duodenal, appendicular perforation or ruptured liver abscess.…”

“…There were associated liver abscesses in 6 patients. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients; stoma was constructed in other 13 patients.…”

Colocutaneous fistula secondary to amoebiasis

“…In one Mexican study of 122 amoeba-related colonic perforations, over 90% were localised to the right colon, with multiple perforations evident in 74% of cases. 10 1 in 3 patients undergoing a right hemicolectomy in this group died, with a general mortality rate of 40% in the entire patient cohort. A Japanese series 11 reports a mortality rate of 92% in those undergoing resection for colonic perforation, though it must be emphasized that both these series span 1970s-1990s and significant progress has been made since in diagnostic techniques, surgical techniques and critical care.…”