Unique Case of a Hamartomatous Duodenal Polyp Associated With Intestinal Schistosomiasis

Abstract

Schistosomiasis is a trematode infection rarely diagnosed in the United States. Intestinal involvement is common with chronic infection and causes abdominal pain, changes in bowel habits, hematochezia, and polyp formation. Chronic, disseminated infection can affect the intestines causing the aforementioned symptoms, but reports of intestinal polyps are rare. Most cases are inflammatory fibrous polyps in the colon. There are very few cases reported in the literature of hamartomatous polyps arising in the small intestine. We present the rare case of a U.S.-born, 35-year-old woman diagnosed with a large duodenal hamartomatous polyp in the setting of intestinal schistosomiasis.

Schistosomal (bilharzial) polyps: Travel through the colon and beyond

“…This previously described mechanism of fibrosis and ova entrapment explain why the Schistosomal eggs are concentrated within the polyps more frequently than in the surrounding mucosa and submucosa[ 8 ]. Furthermore, non-inflammatory polyps associated with Schistosomiasis including adenomatous, hamartomatous, and hyperplastic polyps have been reported[ 1 , 9 ].…”

“…We reported earlier[ 20 ] that, no part of the colon was immune against development of large S. polyps. Many cases presented with solitary S. polyps[ 13 , 16 , 19 , 21 ] even in absence of any Schistosomiasis-related colon inflammation[ 9 , 13 , 16 , 19 , 21 ].…”

“…The described duodenal S. polyps are either small, multiple and sessile[ 31 ] or solitary and large[ 32 ]. One case of dull abdominal pain was diagnosed in the United States with Schistosomiasis complicating a huge duodenal Peutz-Jeghers hamartomatous polyp[ 9 ].…”

“…This association is probable with all forms of urinary bladder- induced Schistosomal pathology including chronic bladder wall inflammation and irritation by the deposited ova, the induced ulcers, sandy patches and also to the developed S. polyps[ 44 ]. There is no clear evidence in the literature linking intestinal Schistosomiasis to bladder tumors and vice versa[ 9 ].…”

“…Linking the developed polyps, whatever its location, with active intestinal or urinary Schistosomiasis is not always achievable. In many cases described in the literature, identification of Bilharzial ova in fresh stool or urine samples taken from the same cases was not possible[ 9 , 16 , 31 ]. Furthermore, S. polyps may be the only clue of a Bilharzial infection[ 19 , 31 ].…”