Authors: César AthiéGutiérrez Heriberto RodeaRosas Clemente GuízarBermúdez Avisaí Alcántara Eduardo E MontalvoJavé
Publish Date: 2009/09/23
Volume: 14, Issue: 1, Pages: 82-
Abstract
Amebiasis is a worldwide health problem that mainly affects developing countries Invasive amebiasis tends to develop complications and among these perforation of the colon although infrequent 19–91 is the most lethal Surgical treatment in these cases should be carried out in a timely fashion prior to the presentation of systemic repercussions or death In the present study we analyzed a total of 122 cases of invasive amebiasisassociated colon perforationWe conducted a clinical retrospective and observational study and presented cases of colonic perforation observed over the past 30 years at the MedicalSurgical Emergency Service of the Mexico Citybased Hospital General de México OD during the 1970–1999 periodDuring this time a total of 19916 emergency abdominal surgeries were performed One hundred twentytwo of these procedures corresponded to cases of colon perforation by ameba which represents 06 80 patients were men 656 and 42 were women 344 with an average age of 48 years Multiple colon perforation was 74 with right colon the most affected 905 Depending on the perforation’s extension and localization right hemicolectomy with ileostomy were performed in 53 patients 4345 subtotal colectomy with ileostomy in 43 3525 left hemicolectomy with transverse colostomy in 12 983 exteriorization of perforated left colon stoma in 13 1065 and primary closure with exteriorization in one patient 08 Postoperative complications were present in 48 patients 393 and 20 cases were related with the creation of a stoma Eighteen of these cases were due to persistent abdominal sepsis and ten due to toxic colon the latter correspond solely to patients with initial nonresective treatment General mortality was 40 with 32 17 of 53 cases of mortality in those submitted to right hemicolestomy 167 two of 12 of left hemicolestomy 442 19 of 43 in those in whom a subtotal colectomy was performed with 769 ten of 13 patients with exteriorization of the perforated right colon and with 100 one of one patient mortality with primary closurePerforation is the most frequent surgical complication of invasive amebiasis of the colon occurring principally in masculine gender and in the fourth decade of life Resection and stoma creation is the procedure of choice that can resolve the septic focus from the first surgical procedure depending on the general status of the patient However morbidity and mortality are high and there is a tendency for these to be lower on comparing initial cases with those with recently conducted surgical procedures
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