A 37-year-old woman was admitted to the hospital because of recent generalized myalgia, fever, and abdominal pain. There was a history of chronic diarrhea for at least three years, with four to six liquid brownish stools per day, without gross blood. Palpation of the abdomen demonstrated considerable tenderness throughout the right side. Rectal examination was painful. There was occult blood (1+) in the stool. The temperature on admission was 38 °C; the hemoglobin level, 6.5 g; and the WBC count, 20,000/cu mm.A plain film of the abdomen (Fig 1) and a diatrizoate (Hypaque) enema examination (Fig 2) were obtained.On the following day, the patient's symptoms became worse and more localized to the right upper quadrant of the abdomen. The temperature rose to 39 °C.
Diffuse amebic colitis with ruptured amebic abscess of the liver.The plain film (Fig 1) demonstrates gaseous distension of small-bowel loops in
Rosenberg LS, Tocino I. Diffuse Colitis With Right Upper Quadrant Mass. JAMA. 1978;240(3):263–264. doi:10.1001/jama.1978.03290030081033
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