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Fig. 1.45 Amebic pericolic abscesses. (A) There is an abscess in the right flank lateral to the ascending colon and outlined by gas within the abscess cavity. (B) Barium enema shows extensive extravasation of barium into the large abscess in the right flank and subhepatic area; the abscess displaces the ascending colon and hepatic flexure medially. (C) Perirectal abscess extending from the right lateral wall of the rectum deep into the pelvic soft tissues in another patient. The large pelvic abscess has caused straightening and lifting of the rectosigmoid colon out of the pelvis. Note the smooth, somewhat tubular contour of the sigmoid colon with loss of haustrations. (D) There is an irregular contour and marked mucosal edema of the third portion of the duodenum, caused by a large pericolic amebic abscess originating from the transverse colon, and identified on a barium enema performed 2 days after this upper gastrointestinal series in a patient from Colombia.

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Fig.1.46 Multiple fistulas and abscesses in two patients with advanced chronic amebic colitis. (A) There is diffuse stenosis and shortening of the colon from the cecum to the mid-sigmoid colon. The mucosa is severely ulcerated, especially in the ascending colon, and there are numerous long fistulous tracts extending from the ascending colon and cecum into the right flank, right upper quadrant, and midabdomen with large abscesses outlined by barium in the right flank and midabdomen. The ascending colon is displaced medially by the large flank abscess lateral to it. This appearance of a stenotic, shortened, ulcerated colon with multiple fistulous tracts and abscesses is indistinguishable from advanced Crohn's disease. (B) Multiple sinus tracts and fistulas extending into the left midabdomen and to the surface of the skin overlying the left lower quadrant where a large, long ameboma is noted in the proximal sigmoid colon. There is also an area of stenosis in the proximal descending colon and considerable deformity of the cecum in this patient from San Salvador with chronic amebiasis. (Courtesy of Dr. Julio Astacio, San Salvador).