Radical surgery for fulminant
amoebic colitis leads to extremely high mortality; however, resective surgery is mandatory if a patient develops massive fecal
peritonitis. We herein report an extremely rare case of fulminant
amoebic colitis with multiple perforations, which was successfully treated by staged
surgical procedures. A 48-year-old man who had been treated with predonisolone under a diagnosis of
ulcerative colitis was admitted. Biopsy specimens from the colonic mucosa revealed Entamoeba histolytica. On the day of diagnosis, he developed severe
abdominal pain and underwent emergency laparoptomy, showing total colonic
gangrene with multiple perforations associated with massive fecal
peritonitis. Subtotal
colectomy, mucous
fistula of the rectosigmoid, and
ileostomy were performed. He recovered well although disseminated intravascular coagulopathy developed postoperatively. As the middle and upper part of rectum was found to be severely stenotic 4 months after surgery, we performed
proctectomy, ileal pouch anal canal anastomosis, and diverting
ileostomy, which was reversed 6 months later. The patient has been well with satisfactory anal function 37 months after the initial surgery. This case suggests that (1). early and accurate diagnosis of
amoebiasis is important to avoid surgical intervention, and (2). staged surgery including total
colectomy should be considered as one of the treatment choices even in patients with total necrotizing
amoebic colitis.