<![CDATA[Hematochezia in diverticulosis is due to vascular rupture at the base of the diverticulum. Concomitant amoebiasis causes colonic mucosal ulceration leading to colitis and severe bleeding and may develop into a perforated colon. This combination is rarely reported and poses a diagnostic challenge due to overlapping symptoms. Hematochezia in a patient with diverticulosis caused by “hidden” amoebiasis was reported. It is important to be alert to amoebiasis among patients with diverticulosis and lower intestine bleeding. An 83-year-old man with a history of diverticulosis 10 years ago complains of fresh, bloody diarrhea of 400 cc each time. Concomitant complaints; sweating and weakness. Examination; anemic conjunctiva, epigastric tenderness, increased bowel sounds, and cold acral. Blood tests; severe anemia (hemoglobin, 6 g/dL), CRP and PCT levels were 9.44 mg/L and 4.37 ng/mL, respectively, suggesting a high risk of sepsis. Endoscopy; Diverticula along the sigmoid to transverse colon, sigmoid erosion. Contrast abdominal CT; diverticulosis along the colon. Feces examination; mucus, erythrocytes, amoeba, and leukocytes. The results indicate diverticulosis and amoebiasis. Blood culture showed gram-negative Pseudomonas. The patient was treated with intravenous fluids, anti-amoeba therapy, and blood transfusions. His condition improved, and he was discharged after 16 days with normal bowel movements, resolved tenderness, a hemoglobin level of 10.2 g/dL, and normal macroscopic and microscopic findings of feces. This case illustrates that amoebiasis can be a hidden and serious cause of hematochezia in patients with diverticulosis. Early recognition and comprehensive management, including hemoglobin monitoring, antiamoebic treatment, and transfusion, are critical for improved outcomes.]]>
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