Huge bilharzial polyp mimicking colon cancer

Abstract

Bilharziasis (Schistosomiasis) is the third devastating tropical disease globally and is endemic in many countries including Egypt. The pathology of chronic colonic schistosomiasis results from egg‐induced immune response, granuloma formation, and associated fibrotic changes that may manifest as bloody diarrhea, cramping, and, eventually, inflammatory colonic polyposis. Huge polyps complicating schistosomiasis are not frequently reported in the literature. Also, huge polyps as a sole manifestation of intestinal bilharziasis are rather rarely reported. Here, we report an Egyptian male patient who presented with bleeding per rectum with a huge polyp on colonoscopy, with morphological traits that mimicked colon cancer and proved to be of bilharzial etiology after surgical excision.

Persistent Colonic Schistosomiasis Among Symptomatic Rural Inhabitants in the Egyptian Nile Delta

“…The presence of colonic schistosomal polyposis does not appear to predispose patients to significant bowel malignancy development. 33,34 There is agreement among authors that S. mansoni is not related to cancer colon. The reported cases of schistosomiasis in patients with bowel malignancy are no more than epidemiological association, [33][34][35][36] and this is consistent with findings of the current study.…”

“…Severe chronic intestinal schistosomiasis may result in colonic or rectal polyposis, stenosis, or present as an inflammatory mass that may be even confused with cancer. [31][32][33] One of the crucial findings of the current study is its ability to assess the colon both morphologically (by endoscopy) and pathologically (by histology) to investigate the extent of S. mansoni induced colon affection. On complete colonoscopy examination, 66.6% of patients have significant lesions (polyps, ulcers, mass-like lesions) while 33.4% had mild mucosal erythema and granularity.…”

“…25 These findings of prevalent schistosomal colon polyps should alarm the endoscopists working in endemic areas to consider schistosomiasis in the differential diagnosis of left-sided colonic polyps. 33 One of the most important retrospective studies 36 that focused on colonic schistosomiasis was carried out in Saudi Arabia and recruited 216 patients with schistosomal colonic disease out of 2458 who had sigmoidoscopy or colonoscopy over 10 years, diagnosed by endoscopic biopsies (prevalence rate of 8.8%). The colonoscopic appearance was suggestive of schistosomiasis in 98 of these patients (45.37%), S. mansoni ova in stool was detected in only 24 of these 216 patients (11.11%).…”

“… 25 These findings of prevalent schistosomal colon polyps should alarm the endoscopists working in endemic areas to consider schistosomiasis in the differential diagnosis of left-sided colonic polyps. 33 …”

Intestinal schistosomiasis mimicking caecal malignancy

“…Management for acute intestinal colitis also centres around oral praziquantel with surgical management reserved for patients with acute intestinal complications such as perforation, bleeding polyps or obstruction 9. There are a few cases of schistosomiasis mimicking colon cancer; however, these were all discovered during colonoscopy and presented as large polyps rather than a caecal thickening 10. At this point in time, we are unaware of any other cases of intestinal schistosomiasis being surgically resected without preceding complications such as bleeding, obstruction or perforation.…”