Ameboma of the rectum is rare, accounting for only 1.5 percent
of cases of invasive amebiasis
5. Invasive amebiasis is
seldom a consideration in the differential diagnosis of
gastrointestinal disease. Therefore, it may progress to one of its
more unusual forms, such as ameboma. The diameters change
from millimeters to few centimeters, and ameboma is found in
decreasing order of frequency in the cecum, ascending colon,
rectum and sigmoid colon, transverse colon and descending
colon and can be detected on physical examination as a tender
palpable mass
6. Clinically most cases are asymptomatic,
with no history of a past acute amebiasis attack. Symptoms are
varied out include alternating diarrhea and constipation weight
loss, low grade fewer, cramp like abdominal pain, fatigue, loss
of appetite and anemia. Especially and localization is with
chronic anal pain and bleeding
2. The case that we reported
was about 50 years old woman who had some complaints about
weight loss, rectal hemorrhage, pain and not to feel relieved
after defecation. The ameboma can be mistaken for a
carcinoma on barium enema
7. Amebic strictures are most
commonly observed in anus, rectum, or sigmoid colon and
must be differentiated from those due to lymphogranuloma
venerum or malignancy. On noninvasive radiological
examinations, the amebomas tend to show and invasion of the
colonic wall circumferentially and macroscopically have a
polypoid appearance. The diagnostic evaluation is difficult to
make only by rectosigmoidoscopical or colonoscopical studies.
Doubled – contrast barium enema graph was performed and
there was no synchronized mass throughout the colon except
the pathology in the anal canal. Differential diagnosis could
only be established by demonstrating the amebic trophozoites
on biopsy specimen. We realized that trophozoites of E.
histolytica as a result of the biopsy and the study of paraffin
blocks cross-sections that had been taken from in another
hospital. We thought that patient had ameboma because the
IHA test also suppoorted serologically. This lesion can imitate
all chronic intestinal granulomatous disease, diverticulitis and
above all carcinoma
8. In all cases, which are suspicious
about inflammatory intestinal disease, the study of rectal
rubbish, rectal biopsy and indirect hemagglutination (IHA)
tests must be done in order to eliminate amebiasis
9,10.
Operation is necessary at the cases in while complications
occur after medical treatment. In the resection, the surgery line
should be far from 3-5 cm of ameboma mass. The operation,
which is made before the initial antiamebic treatment, is not
recommended because of the high complication rate
11. We
also applied antiamebic treatment at the case harmonizing with
literature; after six weeks was observed that the mass was
recovered. Later on we performed Y-V anoplasty for anal
stenosis because this technique is indeed simple and effective.
Patient could be managed with out flap related complications
after operation. There was no postoperative complication at 3,
6, 12, and 24th months, the patient who was called to the hospital after five year for control had no complaints about
defecation. The Y-V anoplasty for benign anal stenosis may be
controversial and needs larger series. As a result, the
physicians should be aware of that is very important to
distinguish amebomas from the other colorectal and anal
tumors and to define them before the operation because these
lesions can be recovered with medical treatment and there
should not to need no need for further operation.
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