Amebic Colitis and the Surgeon

Amoebiasis is a disease of public health importance in developing countries like India. The disease is caused by Entamoeba histolytica. In India, the recorded incidence including the non-pathogenic Entamoeba dispar is 2–55%. Asymptomatic colonization by Entamoeba histolytica accounts for nearly 90% of all cases of intestinal amebiasis. Acute amebic colitis is the commonest manifestation reported in 95% of patients with symptomatic amebiasis. Fulminant necrotizing colitis (FNC) accounts for 0.5–11% of patients with symptomatic amebiasis. Examination of at least three stool samples on three separate days is required to achieve a detection rate of 85–95%. The sensitivity and specificity of monoclonal antibody–based ELISA for detection of E. histolytica-specific antigen in stool specimen is 85% and 90% respectively. Treatment of invasive amebiasis should be started with metronidazole. Current recommendations favour resection ranging from segmental excision to subtotal or total colectomy depending on the extent of colonic involvement. Simple closure of perforation is deemed to fail and not recommended.