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.
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).