Necrotizing amebic colitis: a frequently fatal complication

Acute necrotizing amebic colitis is an uncommon but life threatening development with a high mortality rate, even when properly diagnosed and treated. We report six cases of acute necrotizing amebic colitis, none of which were diagnosed preoperatively. At operation, five of the six patients had friable, necrotic, and gangrenous colon. A right hemicolectomy with ileostomy was performed in two patients and a subtotal colectomy with ileostomy was performed in four patients. Five of the six patients died within 4 weeks of operation. The sole survivor was the patient who had received metronidazole preoperatively. Only after histologic examination of the surgical specimen was the diagnosis made in all cases. If the diagnosis can be made preoperatively and antiamebic therapy instituted, surgical resection may decrease the high mortality rate of this disease.