Beg Mohd Yasir, Bains Lovenish, Mahajan Ratnesh, Lal Pawan, Choudhury Sharmana, Kumar N Pritesh, Momin Eva Wilse C, Pal Veer
Department of Surgery, Maulana Azad Medical College, New Delhi, India.
Department of Pathology, Maulana Azad Medical College, New Delhi, India.
Case Rep Infect Dis. 2020 Aug 11;2020:8845263. doi: 10.1155/2020/8845263. eCollection 2020.
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%. . 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. . 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%.
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.
暴发性坏死性阿米巴结肠炎（FulNAC）是一种在热带国家广泛流行的常见传染病的罕见且严重的并发症。在大多数报道的病例中，只有一段大肠发生坏疽。如我们病例中所见，整个大肠受累非常罕见，死亡率极高，在55%至100%之间。一名50岁男性因急腹症就诊，有腹部绞痛病史，伴有黏液血便和稀便。经过复苏和检查后，患者接受了剖腹手术，结果显示盲肠已脱落，整个大肠有多处穿孔。遂行结肠次全切除术并造瘘。组织病理学检查显示全结肠炎的证据，并有多个阿米巴滋养体菌落。溶组织内阿米巴是一种影响人类大肠和肝脏的原生动物。阿米巴病可有多种表现：无症状感染（90%）、有症状的非侵袭性感染（6 - 8%）、急性阿米巴结肠炎（痢疾）或伴有穿孔的暴发性结肠炎。FulNAC是一种罕见的并发症，难以诊断和治疗，且死亡率很高，在55%至100%之间。
重要的是要考虑到暴发性坏死性阿米巴结肠炎（FulNAC）作为阿米巴病一种罕见且致命并发症的可能性，特别是在阿米巴病流行的热带国家。早期诊断和抗阿米巴治疗，以及对受累肠段进行紧急积极的手术切除并将近端和远端肠管外置，已被证明可降低死亡率。
