11/26/2022 0 Comments Schistosome fluke worm in caThe diagnosis relies on finding ova in stool samples, particularly in early stages of the disease, or in biopsy samples taken at endoscopy in chronic stages. When encountered, the majority of bleeding is due to upper GI tract hemorrhage secondary to schistosomotic portal hypertension. Although schistosomal infection is common worldwide, gastrointestinal bleeding from intestinal schistosomiasis is uncommon in the U.S. Ischemic colitis caused by high ova burden in mesenteric vessels has been reported. Diarrhea is reported in 3-55% of infected people, bloody diarrhea in 11-50%. Chronic intestinal infection may lead to iron deficiency anemia and result in colorectal stenosis. Symptoms of gastrointestinal disease include colicky abdominal pain, poor appetite, and diarrhea with or without hematochezia. Eggs released into the bloodstream by adult worms invade local tissues, including the intestine, where they release toxins and enzymes provoking a TH-2-mediated immune response leading to inflammation, hyperplasia, ulceration, micro-abscess formation, scarring, and polyposis. One in every 30 individuals globally has schistosomiasis, and it is the most common cause of portal hypertension worldwide. An estimated 200 million people worldwide have schistosomiasis, and it is responsible for more than 200,000 deaths annually. Schistosoma are blood fluke parasites endemic to Asia, North Africa, the Middle East, and South America. Repeat colonoscopy two months later showed normal mucosa, with random biopsies showing non-inflamed mucosa with calcified Schistosoma eggs. The patient was treated with Praziquantal, with subsequent resolution of hematochezia. Ascending colon biopsies showed chronically inflamed colonic mucosa with numerous schistosomiasis eggs, and descending colon biopsies showed inflammation with ischemic changes. Stool studies for Clostridium difficile, bacterial culture, and ova and parasite were negative. Colonoscopy revealed an 18-cm contiguous segment of inflamed mucosa with erythema, friability and shallow ulcerations encompassing the descending, transverse, and ascending colon. A CT scan of the abdomen/pelvis showed marked colonic wall thickening from the transverse colon to the rectum. Initial hemoglobin was 13.7 g/dL that decreased to 11.8 g/dL on admission. Exam showed 100 cc of bright red blood per ostomy and a nontender abdomen. Purpose: A 65-year-old Asian male with a remote history of invasive pelvic adenocarcinoma status posttotal cystectomy, ileal conduit, and diverting loop colostomy presented with one day of bright red blood per ostomy and abdominal pain.
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