Schistosomal colonic polyposis: clinical, radiological and parasitological study

One hundred and eight male Egyptian farmers with schistosomal colonic polyposis were reviewed. All patients gave a history of bloody diarrhoea. Sixty-one patients presented with finger clubbing, and four of these patients had painful, tender and swollen wrist, knee and ankle joints. X-ray revealed new bone formation in the bones around these joints. The clinical condition improved with antischistosomal treatment, but the bony changes persisted. Twenty patients showed signs of dependent oedema or ascites. Thirty-one patients had a liver of 8 cm or more below costal margin and 19 patients had a spleen of 8 cm or more below costal margin, a situation not unlike patients with schistosomiasis without polyposis. Fifteen patients had tender abdominal masses in the left iliac fossa which were shown by barium enemas to be clusters of polyps. Anti-schistosomal therapy relieved the obstruction but narrowing persisted in 70% of patients followed up. Severity of schistosomal colonic polyposis correlated with the anatomical distribution of the polyps, with their number and with the egg excretion rates.