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Case Reports
. 2020:74:209-213.
doi: 10.1016/j.ijscr.2020.08.037. Epub 2020 Aug 29.

Large bowel obstruction secondary to schistosomiasis-related colonic stricture

Karan D'Souza  1 , Blake W Birnie  2 , Naisan Garraway  3
Affiliations
Case Reports

Large bowel obstruction secondary to schistosomiasis-related colonic stricture

Karan D'Souza et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Intestinal involvement of schistosomiasis uncommonly involves the formation of non-obstructive polypoid lesions; however, obstructing fibrotic stenoses and strictures secondary to chronic infection are extremely rare with only nine reported cases in the literature.

Presentation of case: An 85-year-old Southeast Asian female originating from the Philippines presents with a one-day history of obstructive symptoms in the setting of chronic constipation over the past four months. Subsequent CT imaging and colonoscopy biopsy revealed a nodular cecal mural wall thickening with chronic inflammation and a single Schistosoma egg. Despite treatment with praziquantel, and medical optimization the patient did not improve. Additionally, a malignancy as the underlying cause of obstruction could not be ruled out as such, she had a right hemicolectomy. Final pathology confirmed the diagnosis of intestinal submucosal schistosomiasis causing fibrotic stenosis.

Conclusion: Obstructing lesions including fibrotic stenoses secondary to Schistosomiasis infection can be managed safely with medical co-morbidity optimization when possible, treatment with Praziquantel and surgical resection of the involved area of colon. Given the risk of malignancy and the inability to clinically distinguish between infectious and neoplastic processes, surgical management is recommended.

Keywords: Case report; Colon; Large bowel; Obstruction; Schistosomiasis; Stricture.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
(A) CT Abdomen and Pelvis illustrating nodular cecal mural wall thickening measuring up to 14 mm and eccentric mural thickening in the terminal ileum measuring up to 7 mm, with marked surrounding fat stranding and numerous prominent surrounding mesenteric lymph nodes measuring up to 8 mm in the short axis. The surrounding peritoneal lining in the right lower quadrant appeared thickened and nodular. (B) The small bowel was diffusely dilated up to 4.9 cm in diameter with air-fluid levels, worst at the terminal ileum proximal to the cecal thickening.
Fig. 2
Fig. 2
(A) Cross-section through colonic stricture showing fibrosis and thickening of the muscularis mucosa, submucosa, and muscularis propria. (B) Calcified Schistosomiasis eggs are identified within the submucosa, (C) associated with a mild, predominately lymphocytic, inflammatory infiltrate. (D) Higher magnification of the Schistosomiasis eggs does not identify any prominent terminal spines.
See this image and copyright information in PMC

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