Cecal amebic granuloma

Introduction The cecal amoebic granuloma is a complication of chronic colitis caused by Entamaeba Histolytica. The cecal amoebic granuloma is caused by long-term unhealed lesions, resulting in a large amount of fibrous tissue, inflammatory infiltration and edema of the mesentery and intestinal wall, and formation of a granulomatous mass, and intestinal stenosis or dyskinesia of the intestinal wall causes intestinal obstruction.

Cause

The cecal amoebic granuloma is caused by long-term unhealed lesions, resulting in a large amount of fibrous tissue, inflammatory infiltration and edema of the mesentery and intestinal wall, and formation of a granulomatous mass, and intestinal stenosis or dyskinesia of the intestinal wall causes intestinal obstruction.

In the acute phase, the macroscopic view of the lesions in the early stage of the intestinal mucosa shows the apical necrosis or shallow ulceration of the needles of most grayish yellow caps. When the lesion progresses, the necrotic lesion enlarges and has a round button shape, surrounded by a bleeding band. At this time, the trophozoites continuously multiply in the intestinal mucosa, destroying the tissue, and passing through the mucosal muscle layer to reach the submucosa. Due to the loosening of the submucosal tissue, the amoeba tends to spread around, and after the liquefaction of the necrotic tissue is detached, a flask-shaped ulcer with a small bottom is formed, and the edge is undermined, which has diagnostic significance for cecal granuloma. The mucosa between the ulcers is normal or exhibits only mild catarrhal inflammation. In severe cases, adjacent ulcers can form a sacral-like communication in the submucosal layer, and the surface mucosa can be necrotic and large, forming a giant ulcer with marginal sneak, which can reach 8 to 12 cm in diameter.

an examination

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: cecal amoebic granuloma often resection after pathological examination, found that most of the trophozoites and cysts in the diseased tissue, in order to confirm the diagnosis.

Differential diagnosis

The cecal amoebic granuloma, sputum enema can only be proved as cecal lesions and can not be identified, so many misdiagnosed as cancer and surgical resection, sometimes mainly manifested as chronic intestinal obstruction can be misdiagnosed as intestinal tuberculosis or localized colitis, often removed After the pathological examination, it was found that there were most trophozoites and cysts in the diseased tissue to confirm the diagnosis.

Intestinal wall edema thickening: dermatomyositis has different degrees of dilatation and segmental changes, with low power and prolonged passage. Intestinal wall edema and thickening can be seen with the naked eye. Microscopic examination revealed multiple mucosal erosions, submucosal edema, muscular atrophy, and fibrosis with lymphatic and plasma cell infiltration. Intestinal submucosal to serosal small artery, venule intima thickening is prone to thrombosis and luminal occlusion.

Intestinal wall fibrosis: schistosomiasis granuloma in the ileocecal area is the venous oocysts that swell into the intestinal wall tissue around the blood vessels, especially the submucosa. Insect eggs cause leukocyte infiltration in the intestinal wall, pseudo nodules are formed, fibrous tissue is proliferated, late intestinal wall fibrosis is thickened, and mucosal proliferation forms granuloma.

Intestinal wall necrosis: It is a simple mechanical intestinal obstruction because it is blocked by intestinal contents such as mites, gallstones, feces or other foreign bodies. More common is that the aphids clump together and cause local intestinal fistulas and block the intestinal lumen. Most common in children, the incidence rate in rural areas is high. The clinical manifestations are paroxysmal abdominal pain and vomiting around the umbilicus, which may have a history of aphids or spit mites.

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