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Acute fulminant necrotizing amoebic colitis leading to intestinal perforation and peritonitis.

Raj P, Sarin YK - APSP J Case Rep (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Maulana Azad Medical College, and associated Lok Nayak Hospital, New Delhi, India.

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Invasive intestinal amoebiasis presenting as cecal perforation is a rare entity in children... In the post-operative period, foul-smelling contents kept coming out through the distal stoma for a week... Colonoscopy was done through the distal stoma, which revealed edematous and ulcerated ascending colon... Biopsy showed the presence of flask-shaped ulcers suggestive of amoebic colitis (Fig.1)... Metronidazole and diloxanide furoate were started and the child gradually improved... He was discharged after 11 days of admission and a month later distal colostogram was done, following which stoma was closed... On the other end of the spectrum acute fulminant colitis with perforation, the most dreaded and feared complication associated with very high mortality rate, may result.[1-5] Management is a bit challenging, as there is low threshold of suspicion for amoebiasis as a cause of perforation, and the diagnosis is made intra-operatively or after the biopsy report... Intra-operatively, the diseased colon is extensively friable and disintegrates with simple manipulation, as happened in our case.[3,4] Eggleston et al and Lubyuski et al advocated diversion and drainage as the main procedure, with resection reserved for gangrenous bowel; mortality associated with resection in these two studies were 71% and 83% respectively.[2,5] The best management for children with amoebic colitis perforation would be the resection of gangrenous colon with stoma formation, as this will not only remove the diseased segment, but also remove the septic foci and prevent further fecal contamination... Once the patient recovers, intestinal continuity may be restored later on after performing distal colostogram to confirm distal patency... Primary repair should always be discouraged as the chances of anastomotic dehiscence are very high due to inflamed and friable bowel... Nil None declared

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Figure 1:Multiple amoebic trophozoites in the necrotic area surrounded by acute inflammation.(Haematoxylin/Eosin x 400). Amoebic trophozoites highlighted magenta pink (PAS stain x400)
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Figure 1: Figure 1:Multiple amoebic trophozoites in the necrotic area surrounded by acute inflammation.(Haematoxylin/Eosin x 400). Amoebic trophozoites highlighted magenta pink (PAS stain x400)


Acute fulminant necrotizing amoebic colitis leading to intestinal perforation and peritonitis.

Raj P, Sarin YK - APSP J Case Rep (2015)

Figure 1:Multiple amoebic trophozoites in the necrotic area surrounded by acute inflammation.(Haematoxylin/Eosin x 400). Amoebic trophozoites highlighted magenta pink (PAS stain x400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4288830&req=5

Figure 1: Figure 1:Multiple amoebic trophozoites in the necrotic area surrounded by acute inflammation.(Haematoxylin/Eosin x 400). Amoebic trophozoites highlighted magenta pink (PAS stain x400)

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Maulana Azad Medical College, and associated Lok Nayak Hospital, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Invasive intestinal amoebiasis presenting as cecal perforation is a rare entity in children... In the post-operative period, foul-smelling contents kept coming out through the distal stoma for a week... Colonoscopy was done through the distal stoma, which revealed edematous and ulcerated ascending colon... Biopsy showed the presence of flask-shaped ulcers suggestive of amoebic colitis (Fig.1)... Metronidazole and diloxanide furoate were started and the child gradually improved... He was discharged after 11 days of admission and a month later distal colostogram was done, following which stoma was closed... On the other end of the spectrum acute fulminant colitis with perforation, the most dreaded and feared complication associated with very high mortality rate, may result.[1-5] Management is a bit challenging, as there is low threshold of suspicion for amoebiasis as a cause of perforation, and the diagnosis is made intra-operatively or after the biopsy report... Intra-operatively, the diseased colon is extensively friable and disintegrates with simple manipulation, as happened in our case.[3,4] Eggleston et al and Lubyuski et al advocated diversion and drainage as the main procedure, with resection reserved for gangrenous bowel; mortality associated with resection in these two studies were 71% and 83% respectively.[2,5] The best management for children with amoebic colitis perforation would be the resection of gangrenous colon with stoma formation, as this will not only remove the diseased segment, but also remove the septic foci and prevent further fecal contamination... Once the patient recovers, intestinal continuity may be restored later on after performing distal colostogram to confirm distal patency... Primary repair should always be discouraged as the chances of anastomotic dehiscence are very high due to inflamed and friable bowel... Nil None declared

No MeSH data available.


Related in: MedlinePlus