Fulminant amoebic colitis with perforation successfully treated by staged surgery: a case report

Area of Science:

• Gastroenterology
• Infectious Diseases
• Surgical Gastroenterology

Background:

• Fulminant amoebic colitis can necessitate radical surgery, carrying high mortality risks.
• Prompt surgical intervention is critical in cases of massive fecal peritonitis due to colonic perforation.
• Immunosuppressive therapy, such as predonisolone for ulcerative colitis, may predispose patients to severe amoebic infections.

Observation:

• A 48-year-old male, initially treated for ulcerative colitis, presented with symptoms of fulminant amoebic colitis.
• Colonic mucosal biopsy confirmed Entamoeba histolytica infection.
• Emergency laparotomy revealed total colonic gangrene with multiple perforations and fecal peritonitis.

Findings:

• The patient underwent a staged surgical approach, beginning with subtotal colectomy, mucous fistula, and ileostomy.
• Postoperative complications included disseminated intravascular coagulopathy, which was managed successfully.
• A subsequent proctectomy with ileal pouch anal canal anastomosis was performed due to rectal stenosis, followed by ileostomy reversal.

Implications:

• Early and accurate diagnosis of amoebiasis is crucial to prevent the need for extensive surgical intervention.
• Staged surgical management, including total colectomy, should be considered a viable treatment strategy for necrotizing amoebic colitis with perforation.
• Successful outcomes in complex cases highlight the importance of tailored surgical planning and management in fulminant intestinal infections.