Acute Fulminant Amoebic Colitis with Multiple Perforations in a Diabetic Female

Abstract Colonic perforation can result from multiple infective and noninfective etiologies, among which amoebic colitis is a recognized cause. Amoebic colitis, a parasitic infection, remains a major public health concern in developing countries such as those in Asia and Latin America, where it is endemic. The incidence is estimated at 1000–5000 cases/100,000 population annually, with 40,000–100,000 deaths reported each year. Fulminant colitis and perforation represent rare but highly fatal complications. Only a limited number of fulminant amoebic colitis (FAC) cases with colonic perforation in previously asymptomatic individuals have been documented in the literature. We report the case of a young diabetic female presenting with severe abdominal pain and vomiting. Clinical evaluation suggested perforated peritonitis, prompting an emergency extended right hemicolectomy. Intraoperatively, gross findings raised a suspicion of malignancy; however, histopathological examination revealed classical flask-shaped ulcers and trophozoites of Entamoeba histolytica with erythrophagocytosis. Diagnosis of FAC is often challenging, as clinical features, laboratory parameters, and radiological findings are nonspecific. Differentiation from other conditions, such as intestinal tuberculosis, colonic carcinoma, and inflammatory bowel disease, is difficult. Hence, a high index of clinical suspicion combined with meticulous histopathological evaluation is crucial for accurate diagnosis, particularly in high-risk individuals.