Acute Severe Pancreatitis and Bilateral Renal Cortical Necrosis

Corresponding Author: Dr Shivanand Gamanagatti Email: shiv223@gmail.com Acute Severe Pancreatitis and Bilateral Renal Cortical Necrosis The diagnosis can be challenging since it may not be possible to distinguish AFNAC from ulcerative colitis or Crohns’ disease since they can have a similar presentation.1-3 Clinical symptoms and signs, laboratory investigations, and radiology remain inconclusive in distinguishing between them. The presence of trophozoites, especially if showing erythrophagocytosis (ingested red blood cells in the cytoplasm) in fresh stool samples of symptomatic patients, was typically considered diagnostic; recently, erythrophagocytosis has been reported in non-pathogenic trophozoites too. Serological tests for amoebiasis are of doubtful value in endemic areas as they cannot distinguish between prior and present infection; antigen detection in stool and molecular techniques using polymerase chain reaction are highly sensitive, but not easily accessible. In the absence of these tests, the only means of definitely establishing the diagnosis may be a demonstration of trophozoites of E. histolytica on histopathology.4 Surgery should be expedited in AFNAC.1-3 Bowel involvement dictates the extent of the colonic resection; primary anastomosis is usually precluded since the colon is very friable, and it is safer to resect and exteriorize the proximal and distal bowel to be restored at a later date.1-3,5 Amoebicidal therapy (metronidazole followed by luminal agents such as diloxanide furoate) should be given in suspected cases, and continued if the diagnosis is confirmed.