Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual

Large bowel obstruction secondary to schistosomiasis-related colonic stricture

•

Schistosomiasis can manifest as non-obstructive polypoid lesions due to deposition of schistosomal eggs.

•

Obstructive lesions, such as fibrotic strictures, secondary to the infectious sequelae of schistosomiasis are rare.

•

Although schistosomiasis can be diagnosed on imaging and laboratory tests, there is no conclusive method of ruling out a malignancy.

•

Praziquantel is a safe and effective treatment for schistosomiasis, and prevents future sequela of the parasitic infection.

•

Surgical resection provides definitive treatment resulting in symptom resolution while ruling out a neoplastic etiology.

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.