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 67-year-old woman from the Philippines with a medical history of psoriatic arthritis, hypertension, osteoporosis, and resected left-sided invasive ductal carcinoma of the breast presented with complaints of chronic lower abdominal discomfort associated with constipation alternating with diarrhea for a year, along with decreased appetite and 20 lbs. weight loss. She denied fever, bright red blood per rectum, or melena. She migrated to the United States from the Philippines in 1998. She never had a colonoscopy in the past. Her family history was negative for cancer. Vital signs and physical examination were unremarkable. Laboratory tests were noncontributory other than normocytic anemia with hemoglobin of 11.6 g per deciliter, no eosinophilia.\nSubsequent colonoscopy revealed a malignant appearing obstructing mass in the distal sigmoid, around 20 cm from the entry site (Figure ). Biopsies from the mass revealed fragments of adenocarcinoma. Pelvic computed tomography (CT) revealed bladder wall thickening (Figure ). Thoracic and abdominal CT revealed no distant metastasis. She underwent successful anterior pelvic exenteration, sigmoid resection with primary anastomosis, and ileal conduit creation for sigmoid cancer invading the bladder. Surgical pathology showed invasive, moderately differentiated adenocarcinoma in the sigmoid colon and numerous Schistosoma eggs in the colon, ovaries, posterior cul de sac, and pelvic wall (Figure ). Along with surgical treatment, the patient was treated with praziquantel (60 mg/kg/d in 2 divided doses). Stool microscopic examination after 4 weeks of treatment was negative for ova and parasites.