Colonic Polyps an Unusual Manifestation of Schistosomiasis

Abstract

Patient: Male, 24-year-old Final Diagnosis: Large rectal polyps secondary to Schistosoma infection • Unusual colonic polyp caused by Schistoma infection Symptoms: Abdominal pain • bleeding per rectum Medication: During the procedure: Xylocaine local gel • Midazolam inj • Fentanyl inj; For the disease: Praziquantel tab Clinical Procedure: Colonoscopy with endoscopic submucosal resection (EMR) • endoscopic submucosal resection (EMR) Specialty: Gastroenterology and Hepatology • Endoscopy Objective: Report of misleading rare disease to avoid an unnecessary invasive intervention Background: Although reports of bilharizial colonic polyps are very rare in the literature, we report a case of a large rectal polyp as a manifestation of chronic intestinal bilharzia. A high index of suspicion in an endemic area is the key factor to avoid unnecessary medical interventions. Case Report: We report a case of a 24-year-old male patient who was married, born in Taiz North Yemen, and worked as a military soldier. He presented to our clinic with a complaint concerning intermittent lower abdominal pain and several months of rectal bleeding. A colonoscopy was performed at the Endoscopy Unit of King Khalid Hospital, Najran, Saudi Arabia on September 23, 2019 and results showed 2 large rectal polyps, (measuring 4×3 and 2×3 cm), located 10 cm from the anal verge, having wide bases and irregular surfaces that mimicked dysplastic polyps. Both polyps became elevated after a normal saline/methylene blue injection. An endoscopic mucosal resection was successfully performed with no immediate complications. The histopathology showed benign polyps due to Schistosoma -induced colonic infection. Conclusions: It is very difficult and challenging to differentiate Schistosoma -induced colonic polyps from other colonic polyps even with an endoscopic evaluation; thus, a high index of clinical suspicion is required mainly in an endemic area, which may prevent the physician from ordering unnecessary interventions and thus avoid severe complications.

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

“…Schistosomal colonic polyps had a wide range of atypical presentations. Elbatee et al [ 19 ], Alyhari et al [ 7 ], and Al-Zubaidi et al [ 22 ], described colo-rectal cancer (CRC) like presentation due to huge polyp size, abnormal polyp morphology or both, respectively. Furthermore, Smith et al [ 23 ], described diffuse colonic polypoid masses with dysensteric features, a picture endoscopically indistinguishable from familial polyposis and severe ulcerative colitis.…”

“…In fact, there is no characteristic morphology for S. polyps[ 45 ]. The huge polyps are commonly mistaken as malignant polyps (Figure 1B ) and in such cases diagnosis is achieved through histopathology either by biopsy or after excision[ 19 , 21 , 22 ].…”

A Rare Case of Huge Schistosomiasis-Associated Cecal Polyp Mimicking Colon Carcinoma

“…Schistosomiasis infection has rarely been reported to cause huge cecal polyps, and a massive polyp presented as the sole manifestation of intestinal bilharziasis is even less frequently encountered. This presentation can be easily confused for a malignant polyp because of the overlap in clinical manifestations and endoscopic appearance of both diseases [ 3 , 4 ].…”

Huge Colonic Granuloma of Schistosomiasis Mimicked Cancer in a 10-Years-Old Child: A Case Report

“…Massive colonic polyps due to schistosomiasis infection are sparsely documented in the literature, and polyps as the only manifestation of intestinal bilharziasis are even less common. 4 , 6 Because most of these cases present as a painless abdominal mass, they can be confused with malignant tumors causing diagnostic difficulties. 4 , 7 …”

“…5 Massive colonic polyps due to schistosomiasis infection are sparsely documented in the literature, and polyps as the only manifestation of intestinal bilharziasis are even less common. 4,6 Because most of these cases present as a painless abdominal mass, they can be confused with malignant tumors causing diagnostic difficulties. 4,7 Here, we report a 10-years-old child who presented with chronic abdominal pain and was diagnosed with a colonic polyp schistosomiasis infection after surgical excision.…”