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Computed tomography scan with triple contrast.
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CT scan revealed segments of grossly dilated large bowel with areas of thickening, deep ulceration, contrast tracking deep within the bowel wall and skip areas with normal bowel wall calibre (Figure 1), suggesting colitis. Colonoscopy revealed areas of inflamed and necrotic mucosa with intervening areas of normal mucosa (Figure 2).
Colonoscopy findings: Areas of normal mucosa (a and b), necrotic mucosa (c and d) and inflamed mucosa (e and f).
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CT scan revealed segments of grossly dilated large bowel with areas of thickening, deep ulceration, contrast tracking deep within the bowel wall and skip areas with normal bowel wall calibre (Figure 1), suggesting colitis. Colonoscopy revealed areas of inflamed and necrotic mucosa with intervening areas of normal mucosa (Figure 2).
Intra-operative picture of the omental 'wrap' involving the caecum and ascending colon.
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At laparotomy, the entire colon was noted to be wrapped with omentum, with no signs of perforation or peritonitis (Figure 3).
Multiple round to oval amoebic trophozoites (black arrow) measuring 6 nm - 40 nm, resembling macrophages, are seen lying freely within debris.
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Histopathological evaluation of the colonoscopically guided biopsy confirmed the diagnosis of amoebic colitis (Figure 4).