Cecal granulomas include cecal amoebic granuloma and ileocecal schistosomiasis granuloma. Cecal amoebic granuloma is a complication of chronic colitis caused by the protozoan Entamoeba histolytica. Ileocecal schistosomiasis granuloma is an advanced-stage lesion of intestinal schistosomiasis, where schistosome eggs deposit primarily in the terminal ileum in addition to the colon.

bubble_chart Pathogenesis

1. Cecal amoebic granuloma Due to prolonged unhealed lesions, a large amount of fibrous tissue forms, along with inflammatory infiltration and edema in the mesentery and intestinal wall, resulting in granuloma-like masses. This leads to narrowing of the intestinal lumen or motility disorders of the intestinal wall, causing intestinal obstruction.

2. Ileocecal schistosomiasis granuloma Schistosome eggs penetrate the intestinal wall through ruptured small veins and embed in the surrounding intestinal wall tissues, especially the submucosa. The eggs induce leukocyte infiltration, pseudonodule formation, and fibrous tissue proliferation. In advanced stages, the intestinal wall becomes fibrotic and thickened, with mucosal proliferation forming granulomas.

bubble_chart Clinical Manifestations

1. Cecal amoebic granuloma presents with localized abdominal pain and intermittent diarrhea; fecal occult blood may sometimes be positive, and a soft sausage-like mass can be palpated in the right lower abdomen.

2. Schistosomiasis granuloma of the ileocecal region often manifests as a palpable mass in the right lower abdomen, accompanied by chronic low small intestine obstruction. The condition typically persists for several months before acute intestinal obstruction symptoms appear.

1. Amebic granuloma of the cecum: The diagnosis is often confirmed only after pathological examination of the resected tissue, where numerous trophozoites and cysts are found in the lesion.

2. Schistosomiasis granuloma of the ileocecal region: A relatively accurate diagnosis can be made by inquiring about exposure history in endemic areas and confirming the presence of schistosome eggs in stool examination.

bubble_chart Treatment Measures

1. Cecal amoebic granuloma This granuloma usually does not require surgical treatment, as medication (chloroquine, diiodohydroxyquin, metronidazole) can achieve good results. For untreated cecal amoebic granulomas, surgical resection may lead to complications such as peritonitis, pericecal abscess, and fecal fistula. Therefore, accurate preoperative diagnosis is of great significance.

2. Ileocecal schistosomiasis granuloma Due to the potential for malignant transformation of ileocecal schistosomal granulomas, surgical resection of the affected intestinal segment with initial stage [first stage] anastomosis is the most definitive treatment. If extensive intestinal adhesions around the lesion make temporary resection impossible, a temporary small intestine fistula or bypass surgery may be performed.

bubble_chart Differentiation

1. Cecal amoebic granuloma: Even a barium enema can only confirm a cecal lesion without differentiation, often leading to misdiagnosis as carcinoma and surgical removal. Sometimes, the primary presentation is chronic intestinal obstruction, which may be misdiagnosed as intestinal tuberculosis or regional enteritis. Only after pathological examination of the resected tissue reveals numerous trophozoites and cysts can a definitive diagnosis be made.