Purpose: Schistosomes infect about 200 million people annually. Schistosoma mansoni is endemic to South America, Africa, and the middle east. Found in fresh water, the parasite makes use of snails as an infective reservoir. Schistosomiasis may persist if untreated. Chronic schistosomiasis may cause hepatic complications, including periportal fibrosis and portal hypertension. We present the only reported case in the U.S. of incidental colonic schistosomiasis within a tubular adenoma eight years following infection. A 56-year-old man presented for colonoscopy for polyp surveillance. He was in good health and free of any gastrointestinal or constitutional complaints. Colonoscopic exam revealed diverticulosis and two small sessile polyps, one in the cecum and one in the rectum. Both polyps were tubular adenomas with epitheloid granulomata. Within the cecal polyp, a schistosome egg was noted. The appearance was consistent with Schistosoma mansoni. On subsequent questioning, the patient reported wading in Lake Eyasi in the Great Rift Valley of Tanzania during an excursion that occurred eight years prior. Pathology slides from his index colonoscopy were reviewed, and showed epithelioid granuloma. He was treated with a one-day course of praziquantel, and his travel companions were referred for serologic testing for schistosomiasis. We present a case of chronic schistosomiasis. Each year, approximately 200 million people are infected with schistosome species worldwide. Free-swimming cercariae leave the snail and penetrate mammalian skin. The parasites migrate to the portal venous system, where they mature. Early symptoms, if present, include a rash at the site of skin penetration. A less common syndrome of fever, myalgia, hepatomegaly, and eosinophilia is also well established. The patient's travel history established a time of infection approximately eight years ago. The endoscopic findings of mucosal congestion and polyps were far from specific. Therefore, the histologic findings of epitheliod granuloma, eosinophilic infiltration of the laminal propria, and schistosoma ova were key to the diagnosis. Both hyperplastic and adenomatous polyps have been associated with schistosomes. A relationship between Schistosoma japonicum and cancer of the large intestinal have been proposed. However, Schistosoma mansoni does not appear to be related to the development of colonic neoplasm. This case represents an unusual finding of chronic schistosomiasis in a patient living in the United States.