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.
We report a 63-year-old Asian female with no significant past medical history, who presented to our clinic reporting an eight-week history of abdominal pain, anorexia, and weight loss. The abdominal pain was mild to moderate, crampy in nature and generalized. It was aggravated with food intake and partially relieved with proton pump inhibitors and probiotics. It was associated with nausea, bloating and an unintentional weight loss of five kilograms in six months. She denied any fever, skin rash, chronic diarrhea or rectal bleeding. She reported traveling back and forth from Hawaii to the Philippines many times before she moved to Florida one year prior. Her physical examination was unremarkable. Her complete blood count and metabolic profile were unremarkable except for a borderline normocytic anemia (hemoglobin at 11.7g/dL). Urine analysis and routine ova and parasites exams in both urine and stool were negative. Right upper quadrant ultrasound was unrevealing. Esophagogastroduodenoscopy (EGD) was unremarkable, as shown in Figure , while colonoscopy showed a 10 milimeter (mm) flat polyp in the descending colon which underwent endoscopic mucosal resection (EMR). Pathology showed hyperplastic colon mucosa with numerous parasite eggs deposition in the submucosa, consistent with Schistosoma species (Figure ). The patient was then treated with Praziquantel (1800 mg in divided doses for one day) and her symptoms, including abdominal pain and bloating, were reported to improve. She also started to gain weight as noted in the two-week follow up visit.\n​​​​​​​