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Jejunal amoebiasis with perforation and spread to mesenteric lymph node
  1. R Mannan1,
  2. V Misra1,
  3. H Saksena2,
  4. P Neogi2,
  5. P A Singh1,
  6. S P Misra3,
  7. M Dwivedi3
  1. 1
    Department of Pathology, MLN Medical College, University of Allahabad, Allahabad, India
  2. 2
    Department of Surgery, MLN Medical College, University of Allahabad, Allahabad, India
  3. 3
    Department of Gastroenterology, MLN Medical College, University of Allahabad, Allahabad, India
  1. Dr V Misra, Department of Pathology, MLN Medical College, University of Allahabad, Allahabad 211001, India; vatsala.m{at}rediffmail.com

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Entamoeba histolytica is a common human intestinal protozoon in developing tropical countries and is considered to be a major cause of morbidity and mortality. It usually colonizes the ileocaecal and rectosigmoid area of the colon and produces small, superficial flask shaped ulcers with their base on the muscularis mucosae. Rarely it may produce transmural necrosis and perforation1 Involvement of jejunum is rare. Its presence in the small intestine leading to symptoms and further complications is rarely reported.24 Extra-intestinal amoebiasis commonly occurs due to vascular invasion.5 Invasion of the lymphatics and spread to draining lymph nodes is rare.6 A case of jejunal amoebiasis with perforation and spread to the mesenteric lymph node is documented here due to its rarity.

A 5-year-old male child presented with fever and abdominal pain for the last 5 days, with 5–6 episodes of vomiting for the last 2 days and inability to pass flatus and faeces since the evening before. The girth of the abdomen had been increasing for the past 2–3 days.

On examination, the child looked malnourished and toxic, with hyperthermia and tachycardia. Pallor was present. There was no icterus or lymphadenopathy. Per-abdominally, signs of peritonitis with guarding and rebound tenderness were present. Bowel sounds were absent.

Chest x ray (posteroanterior view in erect position) did not reveal gas under the diaphragm. Plain x ray of the abdomen in the supine position revealed small bowel distension, and an erect abdominal film showed multiple air …

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