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

Abstract

Acute Fulminant Necrotizing Amoebic Colitis is a rare complication of amoebiasis that is associated with high mortality. Only one to four such cases are seen per year in large hospitals of India, and only few such cases have been reported in the literature. The condition requires early diagnosis and surgical intervention. We recently cared for a patient who presented with acute abdomen with history of intermittent abdominal pain and diarrhea. Before presenting to our institution he was misdiagnosed as a case of inflammatory bowel disease and had been treated with steroids. On emergency exploration, extensive necrosis and multiple perforations in retroperitoneum involving entire colon were seen. Total colectomy with ileostomy was performed. Postoperative course was marked by septicaemia and multi-organ failure followed by death. This case report emphasizes the importance of early diagnosis and treatment of acute FAC, and associated high mortality.

Figure 1.

Total colectomy specimen (Opened), showing multiple large geographic ulcers covered with necrotic purulent slough.

Figure 2.

(A) Ceacal area; and (B). Hepatic flexure of resected colon, showing large ulcers covered with plaques of yellowish necrotic material, appendices is pointed by forceps.

Figure 3.

Splenic flexure of resected colon; large necrotic area with perforation has been shown.

Figure 4.

(A) H & E stained tissue from ulcer base from the resected specimen of colon; arrow indicates the area full of colonies of trophozoits of E. histolytica. (10× magnification), (B) Same area under high power (40× magnification); a colony of trophozoits of E. histolytica can be clearly seen, indicated by arrow.