In the past the diagnosis of amoeboma was made very frequently. Majority of the time the diagnosis was made in the surgical wards It is the surgeons who have encouraged this label because the surgeons always want to label any "lump" which they feel anywhere in the body.

Patients having symptoms of dysentery and having a lump in the right iliac fossa were diagnosed to have amoeboma of the caecum. Similar patients, who had a lump felt on rectal examination, were diagnosed to have a rectal "amoeboma"

The above two diseases do not exist. It is surprising that the latest Oxford Textbook or Medicine (1995 edition) continues mentioning the existence of this disease (as usual the authors have copied from the old edition).

Based on my experience of witnessing hundreds of autopsies of patients who have died of amoebiasis, [1] I have proved that the above two entities do not exist. The lump which the surgeons feel in the right iliac fossa in the case of amoebic dysentery, is the inflammatory mass comparable to appendicular mass. The whole caecum is so inflamed that often there is a leak and localised peritonitis occurs and a lump forms.

Quite often in the past the surgeons used to "open up" these patients. The colon on the operation table was so friable, that invariably these patients died post operatively of faecal peritonitis (in private hospitals autopsies are not conducted). The surgeons operate with the idea that because of Ba enema appearance, there must be some amoebic granuloma of the caecum, and they will try to resect the same as in a case of malignancy of the caecum, which is a differential diagnosis of amoeboma.

These patients will invariably respond to medical treatment and should be treated conservatively, exactly like an appendicular mass. If the Surgeons make the diagnosis of "amoeboma", I can challenge that if the colonoscope

which is made available for investigations (which was not available in olden days) is inserted, nothing will be seen in the caecum except a marked oedematous amoebic inflammation of the mucosa !! (though inserting a colonoscope in a very friable colon may not be safe).

Coming to the rectum; caecum and rectum are the most affected areas in the amoebiasis. The amoebic inflammation is so marked in the rectum, that because of the oedema of the mucous membrane, often "pseudo polyps" get formed. (like ulcerative colitis). These are the pseudo polyps which are being felt by the surgeons and although no autopsy reports are ever been reported as "granuloma". the surgeons continue to call it amoebic granuloma which responds dramatically to a few injections of emetine!

It is high time that the gastroenterologists in India with the help of modern imaging and serological tests and invasive procedures prove to the world that these entities do not exist and write to the editors of Oxford Textbook of Medicine to delete this disease and not misguide the future young budding post graduates!

REFERENCES

1. OP Kapoor. BN Nathwani, VR Joshi. Amoebic Peritonitis. Journal of Tropical Medicine and Hygiene, Jan 1972. 75: 11-15