title: Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.
abstract: BACKGROUND
  Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years.
  
  
  METHODS
  A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved.
  
  
  RESULTS
  Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15).
  
  
  CONCLUSIONS
  Amoebic colonic perforation is associated with unusually high mortality.
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India. bhupendrakjain@gmail.com
authors.forename: Bhupendra Kumar
authors.initials: BK
authors.lastname: Jain
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Garg
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.
authors.forename: Anjay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Mishra
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Mohanty
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D000562:Amebiasis / Q000401:mortality* / Q000601:surgery; D003106:Colon / Q000469:parasitology*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality* / Q000469:parasitology* / Q000601:surgery; D012189:Retrospective Studies