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Fig. 2.34 A-I. The end results of schistosomiasis in the colon may be diffuse bowel wall thickening or local strictures. In these patients with diffuse loss of haustrations, there is narrowing and rigidity of the colon. In A this is evident from the mid transverse colon to the rectum. The patient was a 33-year-old Puerto Rican male and biopsy of the sigmoid showed multiple schistosome eggs. He had been treated 17 years previously. In B the sigmoid colon is shortened, narrowed, and rigid. A polyp found on sigmoidscopy at 15 cm showed schistosome eggs. Biopsy of his rectum (C) showed multiple calcified eggs of S. mansoni in the submucosa with a marked eosinophilic inflammatory reaction. H & E X100; AFIP 68-9019-11, 68-9019-9, 68-9004-1. D The shortened, straightened, and narrowed sigmoid colon of the same patient as in B and C. AFIP 68-9018-2. E A barium enema through a midtransverse colon colostomy shows a long area of stenosis, with irregular thickened mucosal folds in the sigmoid colon. There was also (F) a second irregular stricture with tapered edges below this. The stool contained S. mansoni and histologically there were multiple schistsomal granulomas. (This 33-year-old Puerto Rican female had presented with mechanical large bowel obstruction at the level of the sigmoid colon.) G, H Similar narrowing and stricture in the rectum and rectosigmoid of a Nigerian patient, shown by a barium enema. He was positive for S. mansoni. (Courtesy of Dr. Stanley P. Bohrer) I The final insult: hemorrhoids and schistosomiasis.

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Fig. 2.35 A-G. Schistosomal calcification of the intestine. A A nonenhanced CT scan of a 46-year-old Egyptian showing dense calcification of the sigmoid colon. B The right colon of the same patient. A CT scan without contrast. He was known to have urinary schistsomiasis but had never had any bowel complaints. C, D Plain radiographs show the calcified eggs (arrows) in the bowel wall of a different Egyptian man: the pattern varies with the degree of bowel distension. In C there is laminar calcification, and in D the pattern is more amorphous when the bowel is emptier. E-G The same change in pattern may be seen in rectal calcification. E The rectum is undistended and there is a corrugated, linear pattern (arrows) which is seen through a urine-filled bladder (b) which also has mural calcification. The ureters (u) are also calcified. F The same pattern is seen through the bladder when it is filled with contrast. The widened ureters are also filled with contrast, and there is a clear line of the mucosa between the contrast and the calcified eggs. G When the rectum is distended with gas and feces (arrows) the pattern becomes laminar (u ureter; b bladder). [Courtesy of Dr. S. Fataar et al., Muscat and AJR, 1985 (A-D) and 1984 (E-G)].