A 47-year-old man known to have hypothyroidism and hypertension on treatment presented to the gastroenterology clinic complaining of two-year history of abdominal distension that was worse after oral intake especially milk. He had normal bowel motions and denied nausea and vomiting. There was no previous abdominal surgery. On examination, the abdomen was distended with no tenderness. Colonoscopy was done and showed normal rectum, grossly dilated sigmoid with redundant colonic wall, and mild mucosal inflammation. Abdomen computerized tomography showed distended sigmoid colon with collapsed rectum and no obstruction ().\nAs his symptoms were severe and he already failed conservative management, the patient was referred to general surgery. He underwent laparotomy () and extended hemicolectomy of the affected segment, with colorectal anastomosis. He did well intra- and postoperatively. The pathology unexpectedly showed chronic schistosomiasis in the colonic wall (Figures and ). Upon further evaluation, we found that he lived in the north of Saudi Arabia (Hail) but denied exposure to unclean water or recent travel. His Schistosoma serology titer was high (1 : 1024). Other laboratory findings included slightly elevated direct and total bilirubin (12.3 and 41.5 μmol/L, respectively), normal aminotransferases, erythrocyte sedimentation rate = 11 mm/hour, and C-reactive protein < 3.50 mg/L. He was referred to the infectious disease clinic and was treated with praziquantel. At six-month follow-up, the patient was doing well with resolution of his abdominal symptoms.
A 24-year-old Yemeni male without any previous medical history presented to the emergency department complaining of sudden right-sided chest pain with shortness of breath after taking a shower earlier the same day. Upon questioning, there was no history of trauma, cough, recent travel to potentially endemic areas, recent infection, or any previous similar symptoms. Regarding his vital signs, he was afebrile with a heart rate of 78, respiratory rate of 20, blood pressure of 124/65 mmHg, and oxygen saturation of 96%. He was well-oriented and alert but showed signs of respiratory distress and difficulty in respiration. His chest examination revealed decreased air entry on the right side and normal breathing on the left side. Meanwhile, his other systemic examinations were unremarkable. His investigational panel included complete blood count (CBC) with differential was within normal limits except for isolated eosinophilia. Furthermore, electrolytes and cardiac markers were normal while tuberculosis acid bacilli were negative and blood culture showed no growth. Later, a chest X-ray (CXR) showed right-sided pneumothorax and a collapsed lung (Figure ) with no mediastinal shift. Therefore, the patient was admitted, and a chest tube was inserted accordingly.\nThe following day, a persistent air leak was noted in the chest tube without resolution of the pneumothorax, which raised the suspicion of the presence of a fistula. The following day, the patient underwent bullectomy, pleurectomy, and pleural abrasion via a video-assisted thoracoscopic surgery (VATS). The patient continuous leak was resolved, and there were no signs of an active leak in the following 24 hours. The resected wedge weighed 3 g and measured 3.5 x 2.0 x 1.0 cm. Histopathology cross-section of the specimen was stained with hematoxylin and eosin (H&E) stain showing signs of schistosomiasis eggs of Schistosoma mansoni (Figure ) and was discharged on praziquantel with a follow-up appointment. The patient then failed to follow up further.