A 60-year-old healthy asymptomatic female underwent screening colonoscopy with findings of yellowish rectal subepithelial nodules (measuring up to 5 mm in diameter) (). The patient was referred for endoscopic ultrasound. The patient lived in an endemic area for schistosomiasis in Brazil and had a positive history of freshwater bathing.\nEndoscopic examination was performed under sedation and monitored by an anesthesiologist. A multifrequency radial endoscope was used. Ultrasound revealed the presence of deep mucosal nodular lesions with calcified/hyperechoic inclusions (). There were no alterations in the deeper colonic wall layers. A diagnosis of schistosomal granulomas was considered and biopsies were performed.\nHistologic analysis revealed fragments of colonic mucosa showing increased cellularity in the lamina propria, with mononuclear inflammatory infiltrate and lymphoid follicles. In addition, granulomas in the healing phase were noted with hyaline fibrosis and calcified areas of Schistosoma mansoni. There were no viable eggs noted in the histologic evaluation. The final diagnosis was chronic schistosomal colitis (). The patient was treated with praziquantel (40 mg/kg body weight).
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.