A prospective analysis is presented of a selected group of 45 consecutive patients with transmural
amoebic colitis treated by
laparotomy, colonic lavage and
ileostomy (phase 1 surgery) over 3 years. The diagnosis of
amoebic colitis and amoebic perforation of the bowel were difficult and therefore all patients with '
acute abdomen' had proctosigmoidoscopy and a trial of
metronidazole for 24-48 h before
laparotomy. At
laparotomy, adhesive wraps were present in all patients; 13 perforations were exposed by inadvertent disturbance of adhesive wraps but were successfully closed by
suture to any available organ in close proximity, such as the omentum or small bowel. Four patients (9 per cent) died after phase 1 surgery. After 6 weeks when the
acute disease had healed, 33 of the remaining 41 patients (80 per cent) required closure of
ileostomy only, five had resection of
stricture and three (7 per cent) needed stricturoplasty (phase 2 surgery). Two patients (5 per cent) died after phase 2 surgery. Thus, in surgery for transmural
amoebic colitis adhesive wraps should not be disturbed as they mechanically protect the peritoneal cavity from faecal soiling when perforation occurs. The colon should be emptied by lavage and the faecal stream diverted to avoid secondary bacterial effects.