Complete resolution of obstructive colonic amebic pseudotumo
A 51-year-old male patient presented with acute abdominal discomfort with postprandial abdominal distention, associated with diarrhea of 2 months duration. He had no weight loss, melena, loss of appetite, and no other gastrointestinal symptoms. His family history was unremarkable. Physical examination revealed slight tenderness in the right iliac fossa, where a large mass was palpable. The result of the blood tests including complete blood count, electrolytes, BUN, creatinine, liver function tests, amylase and lipase were unremarkable; biochemical parameters including tumor markers (Ca19.9: 20 U/ml (nl <37 U/ml) and ACE: 1 ng/ml (<5 ng/ml)) were within the normal limits. Parasitology and bacteriology stool examinations showed normal findings.

A computed tomography scan of the abdomen showed marked concentric wall thickening of the terminal ileum and cecum, and an ascending colon tumor measuring 8 × 8 cm, with lumenal narrowing at the level of the hepatic flexure. The tumor showed central low-density content, suggestive of an inflammatory etiology. A colonoscopy showed obstruction at the hepatic flexure; the colonoscope could not traverse the obstruction due to severe lumenal narrowing. However, no notable findings were observed distally to the defined lesion. Histological examination of a biopsy specimen taken from the edematous mucosa by colonoscopy revealed inflammatory cell infiltration without ulceration.

While awaiting results and with a high index of suspicion of an amebic pseudotumor, treatment was initiated with metronidazole (1500 mg/day). Three days after initiation of treatment, the symptoms disappeared; repeated colonoscopy following the improvement of symptoms showed normal large bowel up to 12 cm in the ileum. The treatment was continued for 2 weeks and a repeated abdominal scan showed total disappearance of the tumor.

Source: International Journal of Surgery Case reports

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