Fulminant amoebic colitis: a favorable outcome

Fulminant amoebic colitis (FAC) is often associated with a poor outcome (reported mortality between 55% and 87.5%). We present the outcome of a conservative surgical approach to the management of this condition. Over an 8-year period (January 1992 to December 1999), 23 patients with FAC were managed and prospectively evaluated by a surgical unit at King Edward VIII Hospital, Durban. There were 19 males and 4 females with a mean age of 36 years (range, 18-57 years). Unrelenting abdominal signs was the indication for surgery in all patients. A preoperative diagnosis of FAC was made in 20 patients; in 1 patient the diagnosis was made intraoperatively. FAC was not recognized in 2 patients. The 21 patients diagnosed with FAC were managed by perileal antegrade colonic lavage; 2 patients underwent total colectomy and ileostomy. Following colonic lavage and ileostomy, there was a 95% survival rate (N = 20). Both patients who underwent total colectomy and ileostomy died postoperatively. Patients underwent restorative surgery at a mean period of 7.2 weeks (range, 6-10 weeks) following the initial surgery. The extent of colonic stricturing invariably warranted colonic resection. This included total colectomy (N = 12), right hemicolectomy (N = 5), left hemicolectomy (N = 2), and right and transverse colectomy (N = 1). The overall survival rate of the 23 patients presenting with FAC was 82.6% (N = 19). Early recognition of FAC and a conservative surgical approach are associated with a favorable outcome. Resectional surgery in FAC has a potentially fatal outcome and should be avoided.