FULMINANT AMEBIC-COLITIS - ANALYSIS OF 55 CASES

Fulminant amebic colitis is a rare disease with high morbidity and mor tality. PURPOSE: This study was designed to identify the most frequent clinical and histopathologic features of fulminant amebic colitis and to analyze results of surgical treatment and the existence of risk fa ctors for mortality. MATERIALS AND METHODS: A retrospective analysis w as conducted of clinical and histopathologic data of 55 patients with fulminant amebic colitis. Data were obtained from the files of autopsi es and surgical operations that had been performed at a referral cente r in Mexico from 1943 through 1994. RESULTS: Median age was 52 (range, 18-79) years. There were 34 men (62 percent) and 21 women (38 percent ). Diabetes mellitus and chronic alcoholism were the most frequent dis eases in association with fulminant amebic colitis (40 and 31 percent, respectively). The most frequent clinical manifestations were abdomin al pain, diarrhea, rectal bleeding, and fever. There was a coexistent amebic liver abscess in 54 percent of patients. The main histopatholog ic characteristics were necrosis, presence of trophozoites, and acute and/or chronic inflammation. Of 25 patients who underwent surgery, onl y six survived (operative mortality, 76 percent; overall mortality, 89 percent). The variables that correlated with mortality were longer du ration of symptoms, lower count of leukocytes, nonsurgical treatment, nonresective surgical procedure, hospital admission before 1971, and i nvasion of trophozoites into or through the muscularis. CONCLUSIONS: T he results may help to obtain an earlier diagnosis and establish prope r treatment of fulminant amebic colitis.