In this case, definitive diagnosis was achieved postoperatively by histopathological and microbiological studies. The port of entry of the aspergillus into the bowel wall and the mechanism of such rapid local spread is unclear. Angioinvasion was not seen with special stains in the present case and no evidence of blood dissemination was noted, despite the advanced state of the local disease. In immunocompromised patients, angioinvasion is a noticeable feature in gut aspergillus infection. 8,9,15 Previous reports, and this case, support the view that intestinal aspergillosis does not spread by the lymphatic route.
Gastrointestinal haemorrhage is a known complication of aspergillus infection of the gut.
This may be due to gut infarction, colonic or duodenal ulceration. 15-17 Uncontrollable upper gastrointestinal bleeding due to erosion into the descending aorta, resulting in a rapidly fatal outcome, has been reported in oesophageal aspergilloma. In conclusion, gastrointestinal aspergilloma is difficult to diagnose and carries a very poor prognosis. The authors wish to thank Professor Oluwole J. Ajao, Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia for reading the manuscript. Fungal infections in patients with acute leukemia.