A 20-year-old Ethiopian woman who has lived in Lebanon for the past 3 years presented to our hospital in Beirut, Lebanon, for diffuse colicky abdominal pain and bloating of a couple of years’ duration. This was exacerbated by food intake and relieved by defecation and flatus emission. Symptoms were associated with several bouts of nausea and vomiting. She also reported constipation, with several episodes of mucous in stool, and one episode of moderate amount of fresh blood per rectum. She denied fever, anorexia or weight loss. Her blood profile was normal except for mild anemia (Table ); the results of her urine and stools tests were also normal (Table ). A previously done ultrasound of her abdomen had revealed no abnormalities. A colonoscopy was performed and showed normal colonic mucosa but surprisingly a large (2cm) pedunculated polyp was noted in her ascending colon (Figure ). It was removed by snare under bipolar cautery and sent to the pathologist. The pathologist was puzzled to report a hamartomatous polyp full of partially calcified parasitic Schistosoma mansoni eggs (Figures and ). Random colonic biopsies were taken and showed completely normal mucosa.
Here, we report a 48-year-old Egyptian male farmer who presented to our outpatient clinic with recurrent episodes of fresh bleeding per rectum. The patient had no local causes for rectal bleeding as confirmed by surgical consultation. The laboratory data were as follows: Hb 10.8 g/dL, serum albumin 4.2 g/dL, serum bilirubin 1 mg/dL, serum creatinine 0.9 mg/dL, and negative for hepatitis C virus antibodies. Pan-colonoscopy of the cecum showed a huge polypoidal mass of about 5 cm with broad pedicle 20 cm from the anal verge (Fig. ). Despite the suspicious malignant features of the mass, large size, broad base, eroded surface, and high vasculature, the histopathology showed small bilharzial granulomas (Fig. ), and the patient received a single dose of praziquantel. Six weeks later, a second colonoscopy was performed as the bleeding persisted. No noticeable change in size was observed. The second biopsy was confusing as it did not detect any bilharzial ova or malignancy and showed hyperplastic mucosa. Computed tomography (CT) examination demonstrated the luminal mass and showed circumferential wall thickening in the colon. On these findings, the probability of malignancy could not be excluded, so the patient was referred for surgical resection and anastomosis (Fig. ). The postoperative biopsy proved the pure bilharzial nature of the mass with both fresh and calcified ova.