Cecal amebic granuloma
Introduction
Introduction to cecal amoebic granuloma 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. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in young adults Mode of infection: digestive tract spread complication:
Cause
Causes of cecal amoebic granulomatosis
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.
Prevention
Prevention of cecal amoebic granuloma
Pay attention to food hygiene. Patients with chronic diarrhea should be promptly examined, such as patients with intestinal amebiasis or those with cysts who must be thoroughly treated and isolated from the intestine. If the restaurant industry personnel should be temporarily removed from work. It is also important to vigorously eliminate flies and cockroaches and strengthen manure management.
1. The spread of the disease is mainly caused by contaminated hands, flies, and cockroaches to bring the amoeba encapsulation to food and oral infection. However, most people have no obvious clinical symptoms after infection and become asymptomatic worms; only a few people with low body resistance have clinical symptoms.
2. A large number of amoebic trophozoites can be excreted in the feces of patients with acute amebiasis, but the trophozoites die quickly in the external environment, so the acute infection is generally less. For chronic or asymptomatic worms, the amoeba sac excreted in the feces is more resistant to the external environment, and the general disinfectant cannot kill them. Therefore, these chronic patients, especially the asymptomatic amoeba carrier, are important sources of infection and can transmit the disease to others.
3. Amoeba protozoa is mainly fecal-oral infection, and there are more opportunities for sexual intercourse of the mouth to the anus to contact this source of infection, thereby infecting the amoeba.
Complication
Cecum-amebic granuloma complications Complication
Can be complicated by acute intestinal obstruction and other diseases.
Gastrointestinal manifestations of amyloidosis, acute mesenteric artery embolization or thrombosis, elderly colorectal tumor, primary mesenteric tumor, mesenteric venous thrombosis, mesenteric tumor, cecal granuloma, inflammatory bowel disease Scleritis, intestinal fistula, protein-losing gastrointestinal disease, inflammatory bowel disease and its associated uveitis, intestinal endometriosis, mesenteric lipitis, sexually transmitted diseases-related gastrointestinal infections, ischemic bowel Colic, intestinal polyposis
Symptom
Symptoms of cecal amoebic granuloma Common symptoms Abdominal pain persistent fever Right lower abdominal pain Weight loss Paroxysmal abdominal pain Bowel right lower abdominal pain with vomiting
1. More common in young adults, more than a history of amoebic disease and fever, weight loss, anemia and other systemic performance.
2. Abdominal pain is mostly persistent pain or pain in the right lower abdomen and umbilical cord. Some patients may have paroxysmal abdominal pain with abdominal distension and vomiting.
3. The frequency of stools is increased, which is a thin paste-like stool, the number of times is different, the color is dark red and it is jam-like, and there is stench.
4. The lower right abdomen touches the mass, the boundary is unclear, there is tenderness, the texture is medium, can not be pushed, the intestines and peristaltic waves are visible in the abdomen, and the bowel sounds are active or hyperactive.
Examine
Examination of cecal amoebic granuloma
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.
1. Fecal examination:
(1) Live trophozoite examination method: The trophozoite of the activity is checked by the direct smear method of physiological saline. Microscopic examination revealed red blood cells with more sticky clusters and fewer white blood cells in the mucus, sometimes showing Charcot-Ryden crystallization and active trophozoites.
2) Encapsulation examination method: The iodine liquid smear method is commonly used in clinical practice, and the method is simple and easy.
2. Amoeba culture.
3. Organizational inspection:
Mucosal ulcers were directly observed by sigmoidoscopy or colonoscopy, and tissue biopsy or scraping smears were performed with the highest detection rate.
Diagnosis
Diagnosis and diagnosis of cecal amoebic granuloma
1. Amelian granuloma of the cecum: often after pathological examination after resection, it is found that there are most trophozoites and cysts in the diseased tissue to confirm the diagnosis.
2. Schistosomiasis granuloma in the ileocecal area: If you have a history of exposure to infected areas and positive fecal eggs, you can get a fairly accurate 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.
