The Clinical Significance of Deformity of the Cecum in Amebiasis

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Abstract
Amebiasis is defined as the presence of the Endamoeba histolytica in the wall of the large intestine or in other tissues. The clinical diagnosis of the disease depends primarily upon the demonstration of the organism in one or another of its forms in the stools of the patient. Vallarino (1925) showed that in some cases lesions were produced in the colon which were demonstrable by roentgen methods. Weber (1933) and Bell (1936) demonstrated deformity and shrinking of the cecum in a number of cases of amebiasis. The purpose of this paper is to present a series of cases which confirms the observations of Weber and of Bell and which emphasizes the practical value of recognition of the cecal deformity. No attempt will be made to discuss details of symptoms, treatment, or other aspects of the disease. Incidence of Amebiasis Competent observers believe that amebiasis is not uncommon among the people of the United States. Craig (1940) stated: “In this country numerous surveys have shown that the incidence of the infection varies from one per cent in some localities to as high as 30 to 40 per cent in others. The incidence in 69,000 individuals surveyed in the United States and collected by the writer has been a little over 10 per cent. It may be conservatively stated that from 5 to 10 per cent of the people of this country harbor the parasite and that the percentage is higher in the south than in the north.” Craig and Faust (1943) estimated that 13,000,000 people in this country are infected. In a series of 202 necropsies in accident cases in New Orleans, Faust found E. histolyticae present in the fecal content of the large intestine in 13 (6.4 per cent) and demonstrated amebic lesions in the mucosa in 7. Symptoms The E. histolytica in the large intestine may or may not cause symptoms. Amebic dysentery, i.e., amebiasis with severe diarrhea, occurs in only a small number of patients with amebiasis. D'Antoni (1942) stated that in 1939 amebic dysentery was reported in 2,981 individuals in 33 states with a total population of 107,355,000. “Although these reports probably do not represent the actual number of cases, it is significant that only a small proportion of patients infected with E. histolytica showed dysentery.” D'Antoni believed the non-dysentery cases to be the major problem. The commonest symptoms in the non-dysentery cases (Craig and Faust) are constipation, attacks of slight diarrhea, underweight, colicky pains in the lower abdomen or right lower quadrant, and pains in the head, back, and extremities. The symptoms (D'Antoni) may simulate cholecystitis, peptic ulcer, or appendicitis. The presenting symptom in one of our patients was persistent fever of several months' duration. Fever with leukocytosis was associated with other symptoms in several of our cases. The patients without symptoms are called carriers.
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