Fulminant amoebic colitis in the era of computed tomography scan: A case report and review of the literature

Abstract

Amoebic colitis, caused by ingestion of water or food contaminated with the protozoan Entamoeba histolytica, can progress to a fulminant colitis. Computed tomography (CT) findings reported in the literature on this type of colitis are sparse. We present a 59-year-old male patient with a one-week history of progressive abdominal pain, abdominal distension and associated watery and bloody diarrhoea. A CT scan revealed deep ulcerations with submucosal and intramural tracking of contrast. Colonoscopy and biopsy confirmed a diagnosis of Amoebic colitis. The patient required a laparotomy and demised. Deep ulcerations with submucosal and intramural tracking of contrast on CT are diagnostic of fulminant amoebic colitis. Although not demonstrated at CT in this case, discontinuous bowel necrosis, omental wrapping (seen at laparotomy in our case) and neovascularisation of the bowel wall may be other features to look out for.

FIGURE 1

Computed tomography scan with triple contrast.

FIGURE 2

Colonoscopy findings: Areas of normal mucosa (a and b), necrotic mucosa (c and d) and inflamed mucosa (e and f).

FIGURE 3

Intra-operative picture of the omental ‘wrap’ involving the caecum and ascending colon.

FIGURE 4

Multiple round to oval amoebic trophozoites (black arrow) measuring 6 nm – 40 nm, resembling macrophages, are seen lying freely within debris.