Rare case of acute fulminant necrotizing amebic colitis with lower GI bleeding

A case report published in the Journal of the Association of Physicians of India describes a rare presentation of acute fulminant necrotizing amebic colitis with massive life-threatening lower gastrointestinal bleeding without diarrhea in a 39-year-old male patient.Dr Sanjay Chandnani and colleagues at Department of General Surgery, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra have reported the case.

Amoebic colitis caused by Entamoeba histolytica is a common cause of diarrhea in the tropics. Fulminant necrotizing amoebic colitis (FNAC) is an uncommon but life-threatening complication which can lead to perforation, peritonitis, toxic megacolon, bloody diarrhea and high mortality (40-89%) if not recognized early. It is common in endemic areas, among travelers visiting endemic areas and is often misdiagnosed as Inflammatory Bowel disease initially. Even after appropriate antibiotics mortality rate remains high because of delayed diagnosis and systemic complications.

Amebiasis is water and foodborne protozoal disease infecting as much as 10% of the world’s population and is responsible for 40,000-100,000 deaths annually. It mainly affects the colon and the liver. It has a predilection for both sexes in childhood but males are affected more than females in adults.

The patient was presented cute onset massive bleeding per rectum for one day, associated with dizziness and altered sensorium. There was a spontaneous passage of only fresh blood mixed with clots as well as the passage of blood mixed stools on the day of the presentation. There was no history of abdominal pain, peri-anal pain, straining during defecation, finger evacuation, increased defecation time, mass coming out of per rectum, weight loss, anorexia, urgency or tenesmus. There was no previous history of diarrhea, constipation, abdominal distension, or feeling of a lump.

Colonoscopy was inconclusive as active bleeding obscured the vision. Computed tomography of the abdomen revealed non-specific thickening of the caecum. Emergency laparotomy with right hemicolectomy and temporary ileostomy was performed. Microscopic examination of colonic mucosa revealed Entamoeba histolytica trophozoites with erythrophagocytosis suggestive of fulminant amebic colitis. Intravenous metronidazole was given subsequently and the patient recovered completely. Ileocolonic anastomosis was done after closing the ileostomy three months later.

This case highlights this exceedingly rare presentation of fulminant amebic colitis which poses a diagnostic challenge and can be life-threatening without early surgical intervention.

For detailed case report follow the link: http://www.japi.org/april_2019/1cr.html