Colonic Polyps an Unusual Manifestation of Schistosomiasis

Patient: Male, 24-year-old Final Diagnosis: Large rectal polyps secondary to Schistosoma infection • Unusual colonic polyp caused by Schistoma infection Symptoms: Abdominal pain • bleeding per rectum Medication: During the procedure: Xylocaine local gel • Midazolam inj • Fentanyl inj; For the disease: Praziquantel tab Clinical Procedure: Colonoscopy with endoscopic submucosal resection (EMR) • endoscopic submucosal resection (EMR) Specialty: Gastroenterology and Hepatology • Endoscopy OBJECTIVE: Report of misleading rare disease to avoid an unnecessary invasive intervention BACKGROUND: Although reports of bilharizial colonic polyps are very rare in the literature, we report a case of a large rectal polyp as a manifestation of chronic intestinal bilharzia. A high index of suspicion in an endemic area is the key factor to avoid unnecessary medical interventions. CASE REPORT: We report a case of a 24-year-old male patient who was married, born in Taiz North Yemen, and worked as a military soldier. He presented to our clinic with a complaint concerning intermittent lower abdominal pain and several months of rectal bleeding. A colonoscopy was performed at the Endoscopy Unit of King Khalid Hospital, Najran, Saudi Arabia on September 23, 2019 and results showed 2 large rectal polyps, (measuring 4×3 and 2×3 cm), located 10 cm from the anal verge, having wide bases and irregular surfaces that mimicked dysplastic polyps. Both polyps became elevated after a normal saline/methylene blue injection. An endoscopic mucosal resection was successfully performed with no immediate complications. The histopathology showed benign polyps due to Schistosoma-induced colonic infection. CONCLUSIONS: It is very difficult and challenging to differentiate Schistosoma-induced colonic polyps from other colonic polyps even with an endoscopic evaluation; thus, a high index of clinical suspicion is required mainly in an endemic area, which may prevent the physician from ordering unnecessary interventions and thus avoid severe complications.