Table 2 Endoscopic, surgical findings and outcome of patients with amebic colitis

1

Surgery

Terminal ileum, cecum, ascending colon

Large cecal mass

Extensive flask shaped ulcers with large abscesses with numerous hemophagocytic amebic trophozoites

metronidazole 14 days

5 days later: colonic perforation secondary to amebiasis. Ileostomy. 1 year later: amebic liver abscess

2

Colonoscopy

To transverse

Multiple ulcers

Amebiasis with deep ulcerations

metronidazole 14 days + paromomycin 7 days

Complete resolution of symptoms

3

Colonoscopy

To splenic flexure

Rectosigmoid ulceration/colitis

Acute and chronic colitis. No amebic trophozoits found

metronidazole 14 days + paromomycin 10 days

7 days later: amebic liver abscess

4

Colonoscopy

To descending

Severe rectosigmoid colitis/ulcerations

Surface ulcerations covered by necrotic fibrinous exudate. Many amebic trophozoites in exudate

metronidazole 14 days + paromomycin 20 days

Complete resolution of symptoms

5

Colonoscopy

To ileum

Pancolitis/multiple ulcers

Mucosal edema and ulcerations/necrosis with fibrinous exudate. Hemophagocytic amebic trophozoites in exudate

metronidazole 14 days

Discharged in good condition.

6

Colonoscopy

To cecum

Diffuse inflammation/pseudopolyps

Acute and chronic colitis with superficial erosion/necrosis. Amebic trophozoites present

metronidazole 14 days + paromomycin 10 days

Amebiasis resolved. Diarrhea persists due to ulcerative colitis

7

Colonoscopy

To ileum

Pancolitis/multiple ulcers

Acute colitis. Amebic trophozoites present

metronidazole 14 days + iodoquinol 20 days

Discharged in good condition.

8

Colonoscopy

To cecum

Pancolitis

Acute and focal colitis. Amebic trophozoites present

metronidazole 14 days

Resolution of symptoms

9

Colonoscopy

To hepatic flexure

Fungating, ulcerated, partially obstructing mass in distal sigmoid colon

Invasive Sigmoid Adenocarcinoma. Amebic trophozoites present

metronidazole 14 days + paromomycin 7 days

Chemotherapy