Severe right-sided colitis with asymptomatic multiple large liver abscesses: unusual presentation of amebiasis - 23/08/11
Doi : 10.1016/j.gie.2008.01.031
| Commentary It is likely that the initial site of disease in this patient was the colon, after which access to the liver was gained through the portal vein. In some diseases, such as diverticulitis, streaming in the portal vein may result in left colon disease localizing to the left lobe of the liver and right colon disease to the right lobe of the liver—but apparently not in amebiasis. Another interesting part of this patient’s presentation includes the fact that the liver manifestations were clinically subtle with no right upper quadrant abdominal pain, although there was hepatic tenderness; another reason to always perform careful physical examination! Symptoms of colon involvement (eg, diarrhea or dysentery) are seen infrequently (15% to 30%) in patients with amebic liver abscess, although colon ulcers are present in more than half the patients. The reason for the asymptomatic nature of the colitis may be that colon involvement is usually minor, with small ulcers that involve the right side of the colon. In contrast, symptomatic colon infection is associated with more diffuse ulceration and often involves the left side of the colon. The simultaneous presentation of large liver abscesses and large colon ulcers with massive bleeding is just another unusual feature of this unusual case. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 2
P. 375-376 - agosto 2008 Ritorno al numero
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