RESUMEN
UNLABELLED: Fulminant amebic colitis is a rare disease with high morbidity and mortality. 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 factors for mortality. MATERIALS AND METHODS: A retrospective analysis was conducted of clinical and histopathologic data of 55 patients with fulminant amebic colitis. Data were obtained from the files of autopsies and surgical operations that had been performed at a referral center 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 diseases in association with fulminant amebic colitis (40 and 31 percent, respectively). The most frequent clinical manifestations were abdominal pain, diarrhea, rectal bleeding, and fever. There was a coexistent amebic liver abscess in 54 percent of patients. The main histopathologic characteristics were necrosis, presence of trophozoites, and acute and/or chronic inflammation. Of 25 patients who underwent surgery, only six survived (operative mortality, 76 percent; overall mortality, 89 percent). The variables that correlated with mortality were longer duration of symptoms, lower count of leukocytes, nonsurgical treatment, nonresective surgical procedure, hospital admission before 1971, and invasion of trophozoites into or through the muscularis. CONCLUSIONS: The results may help to obtain an earlier diagnosis and establish proper treatment of fulminant amebic colitis.
Asunto(s)
Disentería Amebiana , Adolescente , Adulto , Anciano , Animales , Disentería Amebiana/complicaciones , Disentería Amebiana/mortalidad , Disentería Amebiana/patología , Disentería Amebiana/cirugía , Femenino , Humanos , Absceso Hepático/complicaciones , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To analyze morbidity-mortality and results of surgical treatment for colonic volvulus. METHODS: Retrospective review of 33 patients who underwent surgical treatment for colonic volvulus from 1986 through 1996. RESULTS: Mean age was 62 +/- 20 years (SD) with predominance of female sex (2:1). There were 25 cases of sigmoid volvulus (76%), 7 in the cecum (21%) and 1 in the transverse colon (3%). Colonic necrosis and/or perforation were most frequently seen in the right and transverse colon (50%) than in the sigmoid (4%) (P < 0.002). Operative morbidity was 45% with mortality of 21%. Age was the only variable statistically significant for operative morbidity (52 +/- 23 years in patients without morbidity vs 71 +/- 17 years in patients with morbidity, P = 0.02). Surgical procedures for sigmoid volvulus were resection in 13 and fixation in 12. Recurrence after fixation was 38% to 12 months and 69% to 24 months (Kaplan-Meier), with associated mortality of 50%. There was no recurrence after resections. Treatment for cecal volvulus was cecopexy in 4 cases, with one recurrence; and right hemicolectomy without recurrence. CONCLUSIONS: The results should encourage resective procedures in sigmoid volvulus because the risk of recurrence after fixation is high and the morbidity-mortality is similar. Elderly patients are more susceptible to complications.