Massive Lower GI Bleeding: A Rare and Life-Threatening Presentation of Intestinal Amoebiasis

Amoebiasis is responsible for around 40,000–100,000 mortalities per year globally and is among the top four causes of death from protozoan infections. Entamoeba histolytica is recognized as a pathogenic amoeba and is associated with both intestinal and extraintestinal manifestations. It has diverse pathogenic mechanisms that cause tissue damage, leading to ulcers and/or abscesses. Intestinal amoebiasis can have a very rare presentation of life-threatening, massive lower gastrointestinal bleeding without diarrhea. We report a case of a male in his late 40s who presented with pain in the right upper abdomen and massive lower gastrointestinal bleeding, subsequently diagnosed with a caecal ulcer as a manifestation of intestinal amoebiasis, along with a liver abscess as an extraintestinal manifestation. Radiological evaluation revealed a right lobe liver abscess with anchovy sauce content on drainage and active contrast extravasation at the cecum. Exploratory laparotomy with right hemicolectomy was performed, and multiple caecal ulcers were present.