Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Raman TANWAR, Sudhir Kumar JAIN, Lovenish BAINS


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case

Year: 2014

Copyright (license): CC BY 4.0


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Summary of article contents:

Introduction

Ileocaecal intussusception is often a surgical emergency caused by various factors, including invasive infections. This report focuses on a case of a 62-year-old man who presented with symptoms consistent with acute intestinal obstruction, specifically due to amoebic colitis, a rare underlying cause. Despite the patient's complaint of acute colicky pain localized in the right iliac fossa and other abdominal tenderness, preliminary diagnoses ranged from acute appendicitis to perforation in the gastrointestinal tract. Diagnostic imaging through ultrasound confirmed the presence of free fluid and a "loop within a loop" structure indicative of intussusception.

Amoebic Intussusception: An Uncommon Presentation

The case highlighted the rare occurrence of ileocaecal intussusception due to invasive amoebic infection, which is not commonly recognized in clinical practice. Upon exploratory laparotomy, surgeons discovered a gangrenous caecum associated with the intussusception, supporting the notion that amoebic infections can indeed manifest through this condition despite being infrequent. Post-operative serological tests confirmed amoebic colitis, while histological examinations revealed numerous ulcers in both the ileum and caecum, along with the presence of amoebic trophozoites. This finding emphasizes the importance of considering amoebiasis as a potential cause of acute abdominal pain and recommends that tropical surgeons be cognizant of invasive amoebic infection before attributing intussusception to idiopathic causes.

Conclusion

The case of this 62-year-old man illustrates that amoebic infections, particularly in tropical regions, can lead to serious gastrointestinal complications such as ileocaecal intussusception. The recognition of such rare presentations is crucial for clinicians, as it may change the management approach and outcomes of patients suffering from acute abdominal symptoms. Before classifying cases of intussusception as idiopathic, health practitioners should thoroughly investigate the possibility of underlying infections like amoebiasis. Adequate treatment for invasive amoebic infections may not only prevent surgical interventions but also reduce the risk of recurrence and associated morbidity in affected patients.

FAQ section (important questions/answers):

What is ileocaecal intussusception and its common causes?

Ileocaecal intussusception is a condition where a part of the intestine telescopes into itself, causing obstruction. It is often seen as a surgical emergency and can be caused by various factors, including inflammatory diseases like amoebic colitis, tumors, or unknown causes.

What symptoms did the 62-year-old man present with?

The patient experienced acute colicky pain in the right iliac fossa, a three-day history of constipation, marked abdominal tenderness, low-grade fever, and no other gastrointestinal tract symptoms, which led to surgical intervention.

How was the final diagnosis of amoebic colitis obtained?

The final diagnosis was made post-operatively through serology and pathological examination of the specimen, which revealed numerous ulcers and acute necrotizing inflammation consistent with amoebic infection.

Why must tropical surgeons consider amoebic colitis in intussusception cases?

Amoebic colitis can rarely lead to intussusception. Considering its prevalence in tropical regions, it’s crucial to investigate it before labeling any intussusception as idiopathic, as this may avoid unnecessary surgeries and complications.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Ulcer:
An ulcer refers to a localized injury to the skin or mucous membrane characterized by the loss of tissue, commonly seen in conditions like amoebic colitis. In the context of the case report, numerous ulcers were noted in the ileum, contributing to the development of intussusception due to inflammation and infectious processes.

2) Pain:
In medical contexts, 'pain' indicates physical discomfort or distress, a critical symptom in diagnoses. The patient presented with acute colicky pain, vital in identifying acute abdominal conditions, like iliocolic intussusception, and guiding the diagnostic process towards serious underlying issues such as amoebic infections.

3) Post:
The term 'post' often refers to the period following an event. In surgical contexts, it denotes the postoperative phase, a crucial time for monitoring recovery and detecting complications. In this case report, postoperative observations revealed positive amoebic serology and histological findings, underscoring the importance of thorough follow-up.

4) Tuberculosis:
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, often affecting the lungs but can present in other organs. In the case report, there was a thorough investigation to exclude TB as a differential diagnosis due to its overlapping symptoms with amoebic infections, especially in tropical regions.

5) Inflammation:
Inflammation is the body’s immune response to infection or injury, often characterized by redness, swelling, pain, and heat. In the patient's case, inflammation of the intestine and surrounding tissues was pivotal in establishing the diagnosis of amoebic colitis, correlating with the surgical findings of ulcers and necrotizing tissue.

6) Shukla (Sukla):
Shukla refers to one of the authors involved in the study, contributing to the research's design, analysis, and drafting. His expertise would be essential in ensuring accurate interpretation and reporting of the case findings, underscoring collaboration in biomedical research and patient care in the discussed case.

7) Patra:
Patra, another author of the study, played an important role in the conception and design of the investigation. His contributions would have significantly impacted the methodology and overall integrity of the research, emphasizing the collaborative nature of medical studies focused on complex cases like amoebic intussusception.

8) Edema (Oedema):
Edema refers to swelling caused by excess fluid accumulation in tissues, commonly associated with inflammation or injury. In the context of the case report, localized edema could indicate the presence of infection or inflammatory processes, potentially contributing to the diagnosis of amoebic colitis and the related complications observed.

9) Blood:
Blood is vital for diagnosing various conditions, providing insights into inflammation, infection, and other systemic changes. In this case report, blood tests showed marked leukocytosis, indicating an immune response to an underlying infection, which correlates with the surgical findings and supports the diagnosis of amoebic infection.

10) Study (Studying):
A study encompasses systematic research to gain insights or validate hypotheses. In this context, the presented case contributes to the body of literature on rare presentations of amoebic infections, emphasizing the need for thorough investigation in similar clinical scenarios to improve diagnosis and treatment efficacy.

11) Giri:
Giri is another of the study's authors, responsible for critical contributions throughout the research process. His role would include assisting in data interpretation and ensuring robust methodologies, highlighting the collaborative efforts necessary for comprehensive medical studies and the clinical significance of the reported case.

12) Wall:
In medical terms, the 'wall' often refers to the physical barriers formed by tissue structures, such as the bowel wall. In the case report, the gangrenous condition of the caecal wall was significant, indicating severe pathology and highlighting the extent of the invasive amoebic infection leading to necrosis.

13) Discussion:
The discussion section of a research report interprets findings, relates them to existing literature, and suggests implications for practice. In the provided case, this section would analyze the rare presentation of intussusception due to amoebic colitis, contextualizing it within broader medical knowledge in surgical emergencies.

14) Antibiotic (Antibacterial):
Antibiotics are medications used to treat bacterial infections. Although used in the patient's management, their relevance in this case revolves around the necessity for proper medical treatment of secondary infections post-surgery and ensuring effective recovery from the initial amoebic infection, which impacted surgical outcomes.

15) Vomiting:
Vomiting is a common symptom reflecting a range of gastrointestinal issues, often indicating an acute abdominal problem. The case report emphasized the absence of vomiting, which helped narrow down the differential diagnosis and steer clinical focus towards conditions like intussusception caused by amoebic infection.

16) Incision:
An incision is a surgical cut made to access internal organs. In the report, the need for a careful incision during exploratory laparotomy was vital to avoid contaminating the surgical field with amoebic organisms, emphasizing the risks involved in operating on infected tissues.

17) Nausea:
Nausea is the sensation of an urge to vomit and is commonly associated with gastrointestinal disorders. The report noted the absence of nausea in the patient, which helped differentiate his presentation from other acute abdominal conditions, focusing suspicion on other causes like intussusception associated with amoebic colitis.

18) Nature:
In this context, 'nature' refers to the characteristics and qualities of amoebic infections and their manifestations in the gastrointestinal tract. Understanding the underlying nature of such infections is essential for effective diagnosis, treatment planning, and anticipating potential complications in clinical practice.

19) Table:
While 'table' in this context may not have been directly mentioned, it often refers to structured data presentation within a study. Data tables can summarize patient demographics, outcomes, and other relevant information, enhancing clarity and facilitating the understanding of results derived from case studies or research findings.

20) Pulse:
Pulse refers to the rhythmic expansion and contraction of arteries as blood flows through them, commonly measured to assess heart rate and vascular health. The patient's pulse rate of 104 bpm in the report indicated tachycardia, suggesting a physiological response to pain and potential infection during evaluation.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘Amoebic Colitis Presenting as Ileocaecal Intussusception - A Rare Case’. Further sources in the context of Science might help you critically compare this page with similair documents:

Differential diagnosis, Tropical countries, Colicky pain, Early diagnosis, Blood test, Ultrasound scan, Case report, Histopathology, Acute appendicitis, Gastrointestinal tract symptoms, Satisfactory outcome, Adult population, Idiopathic, Tissue damage, Tropical region, Amoebiasis, Surgical emergency, Intestinal infection, Amoebic liver abscess, Histology, Acute abdominal pain, Laparotomy, Serology test, Acute abdomen, Exploratory laparotomy, Abdominal tenderness, Intestinal Amoebiasis, Marked leukocytosis, Right hemicolectomy, Amoebic Colitis, Mononuclear cells, Bowel resection.

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