Rectal and colonic mucosal biopsy findings and faeces, sigmoidoscopy, and histopathological correlation in amoebiasis and other colitis.

Abstract

It is rather surprising that despite the ease of obtaining a rectal biopsy and considerable experience of this technique which exist in the routine diagnosis of neoplastic lesions in the rectum, it is only over the last two decades that its application in inflammatory lesions of the colon and rectum has become popular.As amoebiasis is very common in Madras, it had become a necessity to exclude it in all cases presenting with bowel disturbances and vague dyspeptic states, particularly if associated with hepatomegaly.Further, amoebiasis coexists or complicates other colonic or rectal lesions. The various methods available for establishing the diagnosis of amoebiasis have been the demonstration of (a) the vegetative form of Entamoeba histolytica in the faeces, or rectal swab, or scrapings from ulcer or aspirated material from suspected sites or in tissues obtained at biopsy; (b) the cystic form of E. histolytica in faeces; (c) the demonstration of rectal and colonic lesions on sigmoidoscopy; (d) the complementfixation test; (e) fluorescent microscopy, and, (f) the clinical impression and response to antiamoebic treatment.Juniper (1962) observed that 18 out of 22 patients in whom ulcers were seen sigmoidoscopically showed diagnostic trophozoites in mucosal biopsy specimens. Doxiades and Yiotsas (1965) observed amoeba by light microscopy not only in the walls of ulcers as noted by others, but also in 37% of rectal and colonic mucosal biopsy material from regions which were apparently normal at sigmoidoscopy. If this could be corroborated we feel that it will be a very useful procedure in establishing a definite diagnosis in such cases of colitis, non-ulcer dyspepsias, hepatomegaly, and pleuro-pulmonary lesions which are sometimes treated as arnoebic in aetiology purely on clinical impressions.'Paper read at the 7th Annual Conference of the Indian Society of Gastroenterology held at Bombay during September 1966. MATERIALWe are presenting a preliminary report of the colonic mucosal biopsy in 115 patients, in whom a routine faeces examination, proctosigmoidoscopy, and rectal and colonic mucosal biopsy using a long alligator forceps with sharp cupped blades were done. This procedure was carried out without any prior preparation of the bowel.The material obtained onrectal swabs and bysigmoidoscopy was examined under the microscope as a routine and the findings on sigmoidoscopy were recorded. The biopsy specimens were fixed immediately in formalin and then embedded in paraffin. Subsequently paraffin sections were all stained with haematoxylin and eosin. In those where the presence of E. histolytica was suspected on histopathological examination, further sections were taken and stained with iron haematoxylin.Included in this study are 36 cases of acute amoebic dysentery, 12 of chronic intestinal amoebiasis, nine of hepatic amoebiasis, four of pleuro-pulmonary amoebiasis, one of cutaneous amoebiasis, six of bacillary dysentery, nine of ulcerative colitis, 12 of irritable colon, 16 of tuberculous abdomen, and 10 miscellaneou...

Amebic Colitis Can Mimic Tuberculosis and Inflammatory Bowel Disease on Endoscopy and Biopsy

“…[1][2][3][4] Neutrophils have also been mistaken in the past for trophozoites. 15 These above reasons or the endemicity of the disease in Chennai in the 1960s might explain the unusually high rates of amebae in the stools of the patients in the series of Madangopal et al 16 They reported 44 of 48 patients showing trophozoites or ova.…”

Endoscopic findings and lesion distribution in amebic colitis

“…It is often diagnosed by sigmoidoscopy without parasitological examination, and, therefore, amebic colitis is often overlooked. The histopathological findings of amebic colitis and UC may also be similar to crypt abscess [16,17].…”

Differential diagnosis of ulcers throughout the colon

“…Examination of her stool showed that it contained white and red blood cells more than 100 cells/mm 3 and that her stool culture was negative for enteropathogenic organisms. A colonoscopy was performed to exclude malignancy, ulcerative colitis, or infectious colitis.…”

“…Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. [3]. Researches and Diagnostic Center for Emerging Infectious Diseases, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.…”

“…Morakod Deesomsak [1] , Wattana Sukeepaisarnjaroen [2] and Kittisak Sawanyawisuth [2], [3] [1]. Samitivej Hospital, Bangkok, Thailand.…”