Bilharzial Colonic Polyps: Case Presentation

Abstract

Conclusion:This unusual long standing case will give us the chance to recall schistosomiasis, its occurrence as colon polyps, clinical presentation and means of management.

Schistosomal (bilharzial) polyps: Travel through the colon and beyond

“…The most common site for the development of S. polyps is the left colon, mainly recto-sigmoid region[ 3 , 12 ] because mesenteric (especially inferior mesenteric) and pelvic venous plexuses are the final habitat of the adult parasite. However, no part of the colon is immune against development of S. polyps.…”

“…Schistosomiasis in the endemic areas, is associated with development of multiple polyps and multiplicity correlates with the density of infection[ 3 , 18 ]. However, there are many reports that Schistosomiasis can manifest by single colon polyp discovered either incidentally during colonoscopy or complicated[ 13 , 16 , 19 ] even without any clinical manifestations suggestive of Schistosomal infection.…”

“…Schistosomiasis is usually associated with small-sized polyps[ 1 , 3 , 12 ]. However, large-sized S. polyps have been described in many case reports[ 12 , 16 , 18 , 19 ].…”

“…The severe forms of intestinal Schistosomiasis are characterized by the presence of multiple variable sized polyps against a background of diffuse mucosal affection showing mucosal erythema, and ulcerations, a picture mistaken with inflammatory bowel disease[ 3 ]. S. polyps of the colon are usually located in the recto-sigmoid region[ 12 ] and tend to be small[ 3 , 12 ] (Figure 1A ) and dark grey in color with surface ulceration, however other conditions with multiple colonic polyps should be considered in the differential diagnosis.…”

“…Chronic manifestations are related to the establishment of adult worms and trapping of the deposited ova within the tissues and consequently granuloma formation[ 1 ]. The acute presentations include constitutional manifestations with fever, myalgia, urticarial rashes and with ovi-position the manifestations will change to hematuria (urinary Schistosomiasis), diarrhea with blood (intestinal Schistosomiasis), and chronic blood loss; manifested as anemia[ 1 , 3 ]. In chronic cases, development of fibrosis is the hallmark of the disease and this results in devastating sequelae including portal hypertension, hepatic peri-portal fibrosis, and splenomegaly for intestinal Schistosomiasis, while urinary Schistosomiasis is associated with obstructive lesions, increased incidence of stone formation, chronic urinary tract infections, and urinary bladder malignancy[ 4 ].…”