Fulminant amebic colitis: Clinical and pathological analysis

Sixty cases of adult amebic colitis were diagnosed at Chang Gung Memorial Hospital from February 1978 to February 1992. Among them, 16 cases (26.7%), whose symptoms included bloody diarrhea, systemic toxicity, fever, leukocytosis, severe abdominal pain and peritonitis, were diagnosed as fulminant amebic colitis. All the patients were male with a mean age of 59.9 ± 17.3 years. Eight of the 16 patients had other systemic diseases, and 5 patients also had amebic liver abscess. Most of them had leukocytosis (WBC > 10000/mm, in 100%), hyponatremia (Na < 135 meq/l, in 94%), hypokalemia (K < 3.5 meq/l, in 75%), and hypoalbuminemia (albumin < 3.0 gm/dl, in 100%). The diagnosis of fulminant amebic colitis was difficult to make because of its rapid progression and atypical early presentations. In spite of aggressive medical treatment, 13 out of 16 patients still had persistent peritonitis or massive gastrointestinal bleeding. They eventually received emergent surgical intervention. The most common operative finding was colon perforation with abscess formation, and the principal surgical procedure was resection of necrotic colon with drainage. Microscopically, trophozoites with phagocytized RBC in the necrotic ulcers were found in 87.5% of patients. Only 2 of these 13 patients died of sepsis. Three patients complicated with severe systemic medical disease did not receive surgical treatment, and eventually died of septic and hypovolemic shock. The overall mortality rate of fulminant amebic colitis was 31%. In conclusion, early surgical intervention for fulminant amebic colitis must be considered if hypoalbuminemia, leukocytosis, hyponatremia, and hypokalemia are found at admission, or if diarrhea, systemic toxicity, and peritonitis persist despite aggressive medical treatment already conducted.