Amoeboma or carcinoma of the hepatic colon

C M MARSDEN
1947 Journal of the Royal Army Medical Corps  
IT is now generally recognized that Entamceba histolytica can produce a proliferative lesion-an amreboma-which can be very difficult to distinguish from a carcinoma. Much less commonly carcinoma can supervene in a large intestine already affect.ed by the lesions of amrebiasis. . That,this is a rare complication is shown by the fact that only one reference to this association has been found in the English medical journals (Morgan, 1944) . The following case is reported to show the difficulty of
more » ... the difficulty of making a clinical diagnosis of carcinoma from amreboma when the past history of amrebiasis is strong, even though that infection occurred forty years previously. Further we wish to open the possibility of carcinoma of the colon supervening on old and possibly h.ealedamrebic lesions. A. M. B., aged 65 years. The patient was always healthy in his youth and never came under medical care . until, on entering the Army at the age of ·17, he. participated in the South African campaign, being wounded in the chest and left leg. When 22 he proceeded to India, and shortly after arrival began to suffer from chronic ill-health which was only diagnosed' after many months as due to ama:biasis. By then he was having ,severe pain ih the right chest and he was evacuated home, aged 23, with a large liver abscess. On arrival in V.K. the abscess was drained by open operation and 57 oz. of pus obtained. During the next. three years three further liver abscesses were drained. He was then invalided from the Army. When aged 31 the duodenal ulcer from which he had 'Suffered for some time perforated and was sutured. Three years later he suffered another perforation and on this occasion a gastro-enterostomy was performed as well as closure of the perforation. After this the patient had several laparotomies for the division of adhesions producing acute intestinal obstruction. At ~he age of 50 the patient developed a further attack of acute obstruction, this. time 'due to a strangulated inguinal hernia, and following the operation he had several further attacks of obstruction, some treated by division of bands and some by ·gastric suction. The patient remained in fair general health, undertaking a busy administrative post, . and yachting at the week-ends, until January, 1945, when he was 64 years old. He was then forced to stop work by a severe dyspna:a on slight exertion, which had been growing worse for some six months. This was finally diagnosed as due to pernicious anremia and the symptoms were greatly relieved by injections of liver extract. By July, 1945, he was sufficiently well to proceed to Hamburg in the Control Commission Germany. Soon after his arrival he noted that, whereas he had for many years pas~d two stools each morning, he was now passing three or four looser stools, anq suffering from considerable flatulence. Mucus was frequently present in the stools. These symptoms continued and early in 1946 he noticed loss of weight and a
pmid:20241532 fatcat:zerr3yju2nfurpobdmvlha3hu4