Role of adhesive wraps in the pathogenesis of complicated amoebic colitis.

Ischaemic foci within the abdomen attract omental and peritoneal adhesions with neovascularization. Previously it has been shown that transmural amoebic colitis is an ischaemic process. An intra-operative evaluation of the peritoneal barriers in response to necrosis was undertaken during laparotomy in 82 patients with clinical transmural amoebic colitis. At operation the ischaemic colon was covered by adhesive wraps in all patients; peritonitis subsequently was absent in 23 patients (28 per cent), serous in 43 patients (52 per cent), purulent in only 9 patients (11 per cent) and faeculent in another 7 patients (9 per cent). The author regards wrapping as mechanically protective. Wrapping is also a source of neovascularization which was demonstrated on 10 angiograms of resected specimens with transmural disease. This is further supported by clinical finding of subsequent necrosis of colons in three patients whose wraps were disturbed at laparotomy without resection of the colons. Therefore, for both mechanical and vascular reasons, these wraps should not be disturbed.