The roentgen appearance of schistosomiasis Mansoni involving the colon.

Abstract

The medical literature contains numerous reports of the clinical and pathological aspects of schistosomiasis mansoni, but there have been relatively few observations of the radiological manifestations of this disease in the gastrointestinal tract (12). Chait (2) recently reported 6 cases with roentgen appearances of either a stricture or a granulomatous colitis and cites 4 instances from the literature in which the preoperative diagnosis was carcinoma of the colon. The migration of Puerto Ricans harboring this parasite to the larger cities of the continental United States gives practical importance to a knowledge of this disease. In a number of surveys the prevalence of Schistosoma mansoni in the Puerto Rican population has been found to be approximately 10 per cent (16). Thus, in New York City an estimated 50,000 to 75,000 have schistosomiasis. Female worms may continue to produce eggs for ten to twenty years, and patients have been reported to pass eggs after living outside an endemic area for twenty-six to thirty-eight years (10, 18). This group does not represent a public health hazard, as sanitary conditions and the snail population in the continental United States are not adequate to complete the life cycle of the parasite, but it may pose a problem in medical diagnosis. The disease has also beewn reported in American tourists in whom the diagnosis was delayed because of unfamiliarity with schistosomiasis and failure to consider it as a possibility (13). We are presenting our experience with 7 cases of intestinal granuloma associated with schistosomiasis mansoni. Case Reports Case I: M. C., a 16-year-old Puerto Rican female, was first seen at the Presbyterian Hospital in New York complaining of three to seven bowel movements a day for the past six years. At the age of ten an insidious onset of diarrhea consisting of three to seven semi-formed bowel movements daily was noted. For several years the stools had been semiliquid and usually associated with bright red blood. Defecation was associated with pain in the rectum and left lower quadrant. Two years prior to admission, the pain on defecation increased in severity and frequently persisted throughout the day and night, associated with episodes of marked abdominal distention. Four times during the previous six years the patient had been hospitalized at the Municipal Hospital of Fajardo, Puerto Rico, with a diagnosis of intestinal polyps. Examination revealed a thin, moderately well developed young woman with tenderness in the left lower quadrant. The spleen and liver were not palpable. Rectal examination was painful and disclosed irregular polypoid masses 4 to 5 cm above the anorectal junction. A barium enema (Fig. 1) disclosed a lobulated polypoid mass in the midrectum. Proctoscopy revealed numerous nodules of the rectal mucosa ranging from 5 to 8 mm in diameter and grouped to form a polypoid mass 2 cm in diameter.