Large bowel obstruction secondary to schistosomiasis-related colonic stricture

Abstract

Highlights Schistosomiasis can manifest as non-obstructive polypoid lesions due to deposition of schistosomal eggs. Obstructive lesions, such as fibrotic strictures, secondary to the infectious sequelae of schistosomiasis are rare. Although schistosomiasis can be diagnosed on imaging and laboratory tests, there is no conclusive method of ruling out a malignancy. Praziquantel is a safe and effective treatment for schistosomiasis, and prevents future sequela of the parasitic infection. Surgical resection provides definitive treatment resulting in symptom resolution while ruling out a neoplastic etiology.

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

“…The presence of schistosomes in colonic polyps or fibrotic strictures does not rule out the possibility of underlying neoplasm. 14 Expert opinions and published case reports have mentioned that resection of the affected segment is the definitive treatment of partial obstruction of colonic schistosomiasis and confirms the diagnosis with the pathological analysis. 14 , 16 , 17 Furthermore, the literature suggests that once a schistosomiasis polyp has fully developed, it is not amenable to reduction through medical management.…”

“… 14 Expert opinions and published case reports have mentioned that resection of the affected segment is the definitive treatment of partial obstruction of colonic schistosomiasis and confirms the diagnosis with the pathological analysis. 14 , 16 , 17 Furthermore, the literature suggests that once a schistosomiasis polyp has fully developed, it is not amenable to reduction through medical management. In most cases, postoperative praziquantel is used to treat the underlying infection and prevent future disease-related complications.…”

“…Despite their ease to use and low cost, these modalities have low sensitivity and specificity. 14 CT scan is more sensitive and accurate in diagnosing colonic polyps.The most common CT scan findings in colonic schistosomiasis are intestinal wall thickening and calcifications (due to calcification of deposited eggs in the submucosa and subserosa). 12 However, the CT scan manifestations of colonic schistosomiasis are highly unpredictable and harder to identify because they frequently mimic many other pathologic conditions.…”

“… 9 For example, D’Souza et al presented a patient with a significant bowel obstruction, and a CT scan revealed cecal nodular wall thickening that morphologically mimicked cancer and proved to be of bilharzial etiology after surgical excision. 14 …”

Medical Imaging in the Diagnosis of Schistosomiasis: A Review

“…A rare case of the polypoid lesion due to intestinal schistosomiasis was reported in 2020 by D’Souza et al in a patient with a large bowel obstruction. CT scan demonstrated a cecal nodular wall-thickening and after a right hemicolectomy, final histopathological examination showed fibrosis and calcified eggs [ 37 ].…”