Schistosomal Rectal Polyposis Mimicking Colorectal Cancer: A Case Report of a 60-mm Polyp in a Young Ethiopian Man Treated at Firoomsis General Hospital.

Abstract

Background: Schistosomiasis is a major public health problem in endemic regions, affecting over 250 million individuals globally, with Schistosoma mansoni frequently causing intestinal and hepatosplenic disease. Chronic infection may lead to rectal polyposis, which can mimic colorectal malignancy and create diagnostic and therapeutic challenges. Addressing these intersecting diagnostic and therapeutic issues necessitates a comprehensive multidisciplinary approach that integrates increased clinical vigilance in endemic populations, accurate histopathological assessment, focused endoscopic treatment, and antiparasitic therapy. This strategy aims to prevent patients from undergoing unnecessary and debilitating radical surgery.

Case presentation: We report a 25-year-old man from rural Ethiopia who presented with abdominal pain, hematochezia, anemia, and weight loss. Colonoscopy revealed a large pedunculated rectal polyp measuring 60 mm, along with multiple smaller sessile polyps. Histopathology confirmed Schistosoma mansoni ova with intense eosinophilic infiltration and no dysplasia. The patient was treated with praziquantel and iron supplementation; the smaller polyps were completely removed with cold snare polypectomy, and the largest polyp was removed by piecemeal resection with hot snare polypectomy.

Outcome: At the 3-month follow-up, hemoglobin levels improved, stool microscopy was negative for S. mansoni ova, and colonoscopy demonstrated complete mucosal healing with no recurrent polyps.

Conclusion: Schistosomal rectal polyposis closely resembles colorectal cancer, particularly in endemic regions. Histopathological and parasitological confirmation is essential to avoid unnecessary radical surgeries. Early diagnosis, appropriate antiparasitic therapy, and endoscopic management can achieve favorable outcomes, while follow-up colonoscopy ensures long-term disease control.