Vascular occlusion in the pathogenesis of complicated amoebic colitis: Evidence for an hypothesis

Luvuno, F M; Mtshali, Zulu; Baker, L. W.

doi:10.1002/bjs.1800720218

Cited by 30 publications

(19 citation statements)

References 9 publications

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“…Vascular pathology in amoebic colonic disease has been implicated in the pathogenesis of fulminant transmural colitis and has served as the link between amoebic intestinal and extra-intestinal hepatic involvement [23,29]. It has been stated that vascular changes such as dilatation and congestion are common and that "thrombosis is rare, fibrin deposition and vasculitis are never seen" [4].…”

Section: Discussionmentioning

confidence: 99%

Isolated amoebic appendicitis

et al. 2001

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Amoebiasis, a disease of worldwide distribution, is endemic in tropical countries with suboptimal sanitation facilities. Isolated amoebic appendicitis (IAA) is regarded as a rare manifestation of the disease globally. Because there are no defined clinical features that distinguish IAA from bacterial appendicitis, diagnosis is usually dependent on histopathological examination. A 9-year retrospective study was undertaken to investigate the clinicopathological aspects of IAA. The main complaints were fever and abdominal pain. None of the patients had dysentery. The pre-operative clinical diagnosis was acute appendicitis and acute abdomen in 13 and 8 patients, respectively. In all cases the intra-operative diagnosis was acute appendicitis. Gross pathological appraisal revealed peritonitis and perforation in 19 and 17 cases, respectively. Histopathological examination of these appendices demonstrated appendiceal ulceration, transmural mixed inflammation, haematophagous amoebic trophozoites and necrosis in all cases. Vascular pathology comprised venous and capillary luminal plugging (11 cases), necrotising small vessel vasculitis (11 cases), thrombophlebitis of medium sized veins (9 cases) and arteritis with associated thrombosis (1 case). Organising fibrinopurulent peritonitis was present in 19 cases. Two appendices that appeared normal macroscopically demonstrated ulceration and inflammation that were confined to the mucosa and submucosa. All of 18 patients who were treated with metronidazole survived without further surgery, while three patients who were untreated succumbed to the disease. Appendicectomy, accurate histopathological appraisal thereof and optimal, timely management of IAA were critical to the favourable outcome in the present study.

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Section: Discussionmentioning

confidence: 99%

Isolated amoebic appendicitis

et al. 2001

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“…Toxins present in the organism's microfilament, a membrane phospholipase and a phosphoglutamase, which cause mucosal defects, account for the invasive capacity of E. histolytica. 13,14 It has been suggested that the parasite invades the nutrient arterioles with subsequent occlusion and ischemia of the bowel wall, resulting in progression of the initial superficial ulceration to transmural necrosis and perforation. 15 Grossly, the bowel segments were ulcerated and friable.…”

Section: Discussionmentioning

confidence: 99%

Role of histopathological examination in nontraumatic perforation of colon

Singla

Mahajan²,

Agarwal³

et al. 2012

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Aim: Nontraumatic perforation of colon is an uncommon cause of peritonitis requiring early surgical intervention. This study was carried out to determine the prevalence patterns of the different etiologies of nontraumatic perforation of colon. Methods and results: A total of 35 patients with segments of colon or perforation margins removed for perforation were included. Most of the perforations occurred in the caecum, of which two were seen at the ileocaecal junction. The commonest cause was infection (amoebiasis :13 cases and tuberculosis : 5 cases) followed by ulcers of non specific ulcers (12 cases). There were three cases of adenocarcinoma causing secondary perforation and one case of idiopathic intestinal gangrene and volvulus each. Conclusion: In tropics, non traumatic perforations of colon most often involves caecal and ileocaecal segment and the most common etiology is amoebiasis.

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“…However, transmural disease recognised at laparotomy due to omental wrapping of the affected bowel may progress to result in colonic perforation with consequent high mortality. 1 However, amoebiasis involving the ileum is overlooked as it is considered a clinical rarity. In the study of 3013 cases of amoebic dysentery and its complications by Adams and Macleod, 2 not a single case of ileal involvement was reported.…”

Section: Discussionmentioning

confidence: 99%

“…Some 10% of the world's population harbour amoebae but only a proportion of this population ever develop symptoms. 1 Colonic amoebiasis infection and its pathology have been well documented. However, amoebic involvement of the small intestine is still considered a rarity.…”

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confidence: 99%

Amoebic-induced ileal stricturing: a case report

Ahmed

2010

annals

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Infestation with Entamoeba histolytica is worldwide. Some 10% of the world's population harbour amoebae but only a proportion of this population ever develop symptoms. 1Colonic amoebiasis infection and its pathology have been well documented. However, amoebic involvement of the small intestine is still considered a rarity. A case of small bowel obstruction resulting from amoebic induced ileal stricturing is presented. Case historyA 34-year-old Caucasian woman presented with a 2-week history of colicky, central abdominal pain and vomiting. The patient had previously undergone a right hemicolectomy 2 years ago for the removal of an ascending colonic amoeboma in Honduras. The medical report with histology demonstrated the presence of E. histolytica within the mucosa of the resected colonic specimen. She had no other past medical history. On examination, the patient was apyrexial, comfortable at rest but appeared dehydrated. Her abdomen was tender peri-umbilically with hyperactive bowel sounds but no signs of peritonism. Digital rectal examination demonstrated a small quantity of soft stool. Her blood tests were all normal. Plain abdominal radiography demonstrated numerous loops of dilated small bowel. A preliminary diagnosis of small bowel obstruction secondary to adhesions was made and the patient was resuscitated and treated conservatively. A computerised tomographic (CT) scan of the abdomen was urgently arranged and demonstrated markedly distended small bowel loops in the abdomen and pelvis. In the right iliac fossa, there was a transition point with a distal ileal stricture rather than adhesion. This was followed by collapsed terminal ileum (Fig. 1).The patient underwent a laparotomy which demonstrated dilated small bowel proximal to a localised stricture in the terminal ileum with mucosal ulceration and enlarged mesenteric lymph nodes. Resection of 15 cm of terminal ileum with an end-to-end anastomosis was performed. Postoperatively, the patient was commenced on intravenous fluids and a combination of 500 mg of intravenous metronidazole and 1.2 g of co-amoxiclav, 8-hourly. The patient made a good recovery and was discharged when tolerating diet with a 7-day course of oral metronidazole 400 mg 8-hourly in view of the possibility of previous E. histolytica infection.The patient was reviewed in the out-patient clinic with continuing symptoms. The histology demonstrated a transmural inflammation composed of a dense, mixed, Amoebic-induced ileal stricturing: a case report MUNEER AHMED Department of Vascular and General Surgery, New Cross Hospital, Wolverhampton, UKABSTRACT A case of small bowel obstruction resulting from amoebic-induced ileal stricturing is presented.

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Vascular occlusion in the pathogenesis of complicated amoebic colitis: Evidence for an hypothesis

Cited by 30 publications

References 9 publications

Isolated amoebic appendicitis

Isolated amoebic appendicitis

Role of histopathological examination in nontraumatic perforation of colon

Amoebic-induced ileal stricturing: a case report

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