Fulminant Necrotising Amoebic Colitis of Whole of Large Bowel: A Rare Complication of a Common Infectious Disease

Abstract

Background. Fulminant necrotising amoebic colitis (FulNAC) is an uncommon and grave complication of a very common infectious disease widely prevalent in tropical countries. In most of the cases reported, only a segment of large bowel was gangrenous. The involvement of the whole of the large bowel, as in our case, is very rare and has very high mortality ranging from 55% to 100%. Case Summary. A 50-year-old gentleman presented with an acute abdomen with a history of crampy abdominal pain and passage of blood mixed with mucous and loose stools. After resuscitation and investigations, the patient was taken up for laparotomy and the findings showed that the caecum was sloughed off and the entire large bowel had multiple perforations. Subtotal colectomy with ileostomy was performed. Histopathological examination showed evidence of pancolitis with multiple colonies of amoebic trophozoites. Discussion. Entamoeba histolytica is a protozoon that affects the large intestine and liver in humans. There can be various presentations of amoebiasis: asymptomatic infection (90%), symptomatic noninvasive infection (6–8%), acute amoebic colitis (dysentery), or fulminant colitis with perforation. FulNAC is an uncommon complication, difficult to diagnose and treat, and associated with a high mortality rate, ranging from 55% to 100%. Conclusion. It is important to consider the possibility of fulminant necrotising amoebic colitis (FulNAC) as an uncommon and fatal complication of amoebiasis, especially in tropical countries, where amoebiasis is prevalent. Early diagnosis and antiamoebic treatment, along with urgent aggressive surgical resection of the involved segment and exteriorization of the proximal and distal bowel ends, are shown to reduce mortality.