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.
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.