Colon

The large bowel is not commonly affected by S. haematobium but this can occur, especially in combination with S. mansoni (Fig. 2.32). The most common presentations are of a granulomatous type of colitis (often in the transverse colon) and proctitis (Fig. 2.29).

Rectal and colonic calcification may be seen, most commonly in the right side of the colon. It is always associated with bladder or ureteric calcification. The pattern varies with the state of distention of the bowel and may therefore change frequently. The calcification may be laminar or amorphous or corrugated. If the bowel is distended, the laminar or linear pattern is likely, whereas the corrugated pattern is more common in the rectum, especially when empty. Calcified eggs may be recognized on CT and, rarely as bright echoes on ultrasound in the pericolonic or perirectal tissues. There is no clinical correlation between the extent of colitis or polyposis and the presence of bowel calcification.

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Fig. 2.29 A, B. S. haematobium can cause a granulomatous reaction in the large bowel. A Superficial ulceration and edema causing irregularity of the right half of the transverse colon in a 30-year-old African. The normal haustral pattern is lost and the lumen is slightly narrowed. B Extensive granulomatous proctocolitis of the rectosigmoid colon in another African patient. Normal haustration can be seen in the descending colon, just visible at the top of the radiograph.

Central Nervous System

It is very rare for S. haematobium to affect any part of the central nervous system, but it can happen. Paraplegia due to granulomatous arachnoiditis and to transverse myelitis are recorded (Fig. 2.65) . (One patient with transverse myelitis was pregnant.) But the majority of CNS symptoms will be due to S. mansoni or S. japonicum.