[Early endoscopic diagnosis can save lives and reduce the extent of colon resection for acute fulminant amebic colitis: a case report with review].

A man in his 50s was referred to the hospital with fever, right lower abdominal pain, and bloody diarrhea. Based on computed tomography images and characteristic varioliform erosions observed during the colonoscopic examination, the patient was diagnosed with fulminant amebic colitis. Intravenous metronidazole was administered immediately. After symptom improvement, a second colonoscopic examination revealed inflammation localized to the right hemicolon. A right colectomy was performed on the 75th hospital day, and the patient was discharged without further problems. Prompt antiamebic therapy based on early endoscopic diagnosis was effective in quelling colonic inflammation in a life-threatening case of acute fulminant amebic colitis. Moreover, colonoscopic reexamination was useful in determining the extent of inflammation and minimizing colon resection.

Spectrum of CT findings in amebic colitis.

Entamoeba histolytica is distributed throughout the world. Invasive amebiasis affects millions of people globally, and the associated complications cause 40,000-100,000 deaths per year. In countries where fecal-oral transmission is unusual, amebic colitis is not common, and the infection may be seen in travelers to and emigrants from endemic areas. Without adequate treatment, amebic colitis may develop into fulminant and become rapidly fatal. With the current increase in global mobility, amebic colitis should be suspected even in patients not in the endemic areas. CT plays an important role in the diagnosis of amebic colitis by demonstrating the presence of colitis with the typical involvement of the cecum and rectum. Pathological features of atypical involvement are also demonstrated. Since preoperative diagnosis can reduce the mortality associated with necrotizing colitis, radiologists need to recognize the typical as well as atypical CT findings of amebic colitis. Considering this requirement, this paper aims to describe the histopathologic features of amebic colitis and to illustrate the spectrum of corresponding CT findings.

Colitis amebiana necrosante, presentación de un caso / Necrotizing amebian colitis, case report

Resumen Introducción: La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) han definido la amebiasis como la infección por Entamoeba histolytica, independientemente de los síntomas. La colitis amebiana necrosante es una forma rara de amebiasis que se asocia con una alta morbilidad y mortalidad. Caso clínico: Presentamos a un paciente femenino de 68 años, con antecedentes de diabetes mellitus tipo 2, con colitis amebiana necrosante con múltiples perforaciones, que fue sometida a una hemicolectomía derecha con íleo-transverso anastomosis. Conclusiones: Se necesitan intervenciones efectivas para prevenir la colitis amebiana y terapias adicionales para tratar la colitis amebiana fulminante y mejorar los resultados.

Abstract Background: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. Case Report: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. Conclusions: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

Multiple simultaneous infections in a patient with well-controlled HIV: when Occam's razor fails.

Multiple concurrent infectious processes have previously been reported in the context of advanced HIV with significant immunosuppression. Here we report a case of multiple infections in a 56-year-old man with well-controlled HIV diagnosed 5 years earlier. Soon after returning to Australia following 12 years living in Thailand, he became unwell with fevers, night sweats, arthralgia and myalgia. There were no localising symptoms and examination was unremarkable. Investigations revealed positive syphilis (Treponema pallidum) serology with an RPR of 16, a positive urine culture (Klebsiella pneumoniae), a pulmonary nodule, a liver abscess and colitis (Entamoeba histolytica). Recovery was only complete when all the individual infections were treated.

Amoebic-induced ileal stricturing: a case report.

A case of small bowel obstruction resulting from amoebic-induced ileal stricturing is presented.

A case of fulminant amebic colitis with multiple large intestinal perforations.

Amebic colitis normally causes mucous and bloody diarrhea stool as predominant symptoms, thus leading to a course of chronic colitis. However, though rare, there exists a fulminating type that causes intestinal perforations due to wide necrosis of the large intestine. We encountered a case of fulminant amebic colitis that lead to death due to multiple large intestinal perforations. The patient was a 72-year-old female. The patient was admitted to our hospital with symptoms of fever, abdominal pain, and diarrhea. She continued to have a fever of over 38 degrees C and increased left abdominal pain. An abdominal computed tomography scan revealed free gas on the abdominal side of the kidney. Therefore, gastrointestinal perforations were diagnosed and surgery was performed. In surgery, many perforated parts were observed from the appendix to the descending colon, and subtotal colectomy was performed. However, sepsis and disseminated intravascular coagulation occurred, and the patient died on the eighth postoperative day.

High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects.

AIM: The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects. METHODS: Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired. RESULTS: Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed. CONCLUSION: B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.

Ultrasonographic findings of amebic colitis.

We present here a case of a 64-year-old man with amebic colitis who was examined by ultrasonography. Gray-scale ultrasonography revealed marked thickening of the bowel wall, specifically thickening of the submucosal layer. Color Doppler ultrasonography showed hypervascularity of the submucosal and proper muscle layers. With effective treatment, thickening and hypervascularity of the bowel wall disappeared promptly. This is the first report demonstrating ultrasonographic findings of amebic colitis. We conclude that information provided by ultrasonography is useful not only for detecting the bowel abnormality of amebic colitis but also for evaluating the therapeutic effect on amebic colitis.

Diseases of the cecum: a CT pictorial review.

Cecal pathology is commonly encountered and may represent a diagnostic challenge in patients with either acute or chronic clinical presentations. Although appendicitis accounts for the majority of surgical conditions presenting with right lower quadrant pain, readers should be aware of the broad spectrum of cecal pathologies and characteristic CT findings, which can be useful in establishing the correct diagnosis.

Transient appendiceal enlargement in a patient with colonic amebiasis: sonographic detection and follow-up.

A case of colonic amebiasis with no clinical signs of acute appendicitis but with sonographic visualization of an enlarged appendix is reported. As antiamebic therapy resolved the clinical signs and symptoms of the amebiasis, the sonographic appearance of the appendix returned to normal. Thus, an enlarged appendix does not necessarily indicate clinical appendicitis in patients with colonic amebiasis.

[Invasive amebiasis]. / Invazív amoebiasis.

There has only a small number of invasive amoebiasis cases occurred in Hungary up to now. Introducing two of our cases we would like to call attention on these cases coming mainly from tropical countries or having been just transiently there invasive amoebiasis should also be considered. Modern diagnostic imaging technics are of importance in differential diagnosis in showing antibodies against amoebas (!) because amoebas frequently cannot be directly shown from the patients in the invasive stage. Both ulcerous amoebic colitis and amoebic liver abscesses can be treated with drugs affecting amoebas in deep tissues (metronidazole, emetine, and its derivates, etc.).

Ultrasonic patterns in inflammatory bowel disease.

Ultrasound examination was performed in 90 patients with varying bowel pathology. Ultrasound reliably demonstrated thickening of the bowel. In addition, the pattern of abnormality seen in Crohn's disease and ulcerative colitis was different, and corresponded to the pathological changes seen in these disease processes. The pattern of bowel abnormality seen in other bowel diseases with an inflammatory aetiology generally corresponded to either the Crohn's or ulcerative colitic pattern. The appearances are described, together with findings in other non-neoplastic diseases of the bowel.

The value of double-contrast barium enema in amebic colitis.

We report here our findings on the double-contrast barium enema given to 8 patients with amebic colitis and a comparison is made with endoscopic features. A definite diagnosis of amebic colitis was made by fecal examination or by endoscopic biopsy. Radiologic findings included fine marginal serration, aphthoid ulcers, minute barium flecks, marginal defects, loss of haustration, and deformities of the bowel. Aphthoid ulcers and marginal defects are both characteristic of amebic colitis. The double-contrast barium enema is most useful for differentiating amebiasis from other forms of colitis.