Premkumar Madhumita, Devurgowda Devaraja, Dudha Shivani, Kulkarni Anand, Joshi Yogendra Kumar
Senior Resident, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi; *Corresponding Author.
Senior Resident, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi.
J Assoc Physicians India. 2019 Mar;67(3):14-18.
Intestinal amebiasis is endemic in India, with myriad clinical presentations. The liver is the most common extra-intestinal organ to be involved in invasive amoebiasis up to 37% of cases. Synchronous presentation of hepatic and intestinal disease is unusual, and presentation as acute gastrointestinal bleed, or amoeboma even more atypical.
We aimed to assess the frequency of synchronous hepatic and colonic amebiasis and the efficacy of endoscopic management of colonic bleeding.
We screened 52 consecutive patients with amebic liver abscess for synchronous intestinal amoebiasis and report the clinical course of 28 patients (mean age 48.3 years, all male) with amoebic liver abscess (ALA), (mean size, 7.2 ± 2.8 cm) who presented to us with lower gastrointestinal bleed requiring endotherapy. Patients with synchronous infection had higher bilirubin, liver enzymes and prothrombin time. Most needed percutaneous drainage of the liver abscess, and had prolonged hospital stay. They had ileocaecal ulcers with active bleeding; ulcer with adherent clot in 10(50%), and visible vessel in 8(37.5%), or active ooze in 4(12.5%). One patient had an ulcerated rectal mass, which appeared malignant on endoscopy, which was later found to be an amoeboma on microscopy. Hemostasis was achieved with dilute epinephrine injection, one patient required argon plasma coagulation, and 4 subjects required haemoclip placement at the site to control ooze from a visible vessel.
Synchronous hepatic and intestinal amoebiasis is not uncommon, and often requires endoscopic haemostasis in case of gastrointestinal bleeding due to colonic disease. We report the successful endoscopic control of bleeding amoebic ulcers in all 24 patients.
肠道阿米巴病在印度呈地方性流行，临床表现多样。肝脏是侵袭性阿米巴病最常累及的肠外器官，高达37%的病例会出现这种情况。肝肠疾病同时出现并不常见，而表现为急性胃肠道出血或阿米巴肿则更为罕见。
我们旨在评估肝结肠同步阿米巴病的发生率以及结肠出血内镜治疗的疗效。
我们连续筛查了52例阿米巴肝脓肿患者以寻找同步性肠道阿米巴病，并报告了28例（平均年龄48.3岁，均为男性）阿米巴肝脓肿（ALA）患者（平均大小为7.2±2.8厘米）的临床病程，这些患者因下消化道出血前来接受内镜治疗。同步感染的患者胆红素、肝酶和凝血酶原时间较高。大多数患者需要经皮引流肝脓肿，住院时间延长。他们有回盲部溃疡伴活动性出血；10例（50%）有附着血凝块的溃疡，8例（37.5%）有可见血管，4例（12.5%）有活动性渗血。1例患者有溃疡性直肠肿物，内镜检查时看似恶性，后来显微镜检查发现是阿米巴肿。通过注射稀释肾上腺素实现了止血，1例患者需要氩离子凝固术，4例患者需要在出血部位放置止血夹以控制可见血管的渗血。
肝肠同步阿米巴病并不罕见，结肠疾病导致胃肠道出血时通常需要内镜止血。我们报告了所有24例出血性阿米巴溃疡患者内镜止血均成功。
