An Ethiopian Woman with an Incidental Finding During a Cesarean Section
Authors' addresses: Regev Cohen, The Ruth and Bruce Rappaport Faculty of Medicine Technion, Infectious Diseases Unit, Sanz Medi- cal Center, Laniado Hospital
Rappaport Faculty of Medicine Technion, Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital
16 Divrei Haim Street, Kiryat Sanz, Netanya 42150
and Igor Igov The Ruth and Bruce Rappaport Faculty of Medicine Technion, Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital
Surgery Department, Sanz Medical Center, Laniado Hospital
This patient shows a rare phenomenon of schistosomal ova deposition on the serosal side of the small bowel without any pathology seen on the mucosal side of the small and large bowels. The patient was diagnosed accidentally during an elective cesarean section, when small nodules were seen on the small bowel surface. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A 26-year-old human immunodeficiency virus
(HIV)negative woman of Ethiopian descent was admitted for an
elective cesarean section. During the operation, multiple nodules
were noticed on the serosal surface of the small bowel (Figure 1).
An excisional biopsy of a nodule showed granulomatous
inflammation with eosinophils around an egg (Figure 2).
The patient immigrated to Israel 15 years before admission
and was asymptomatic, except for mild chronic constipation
and episodic dysuria. She denied hematuria, hematochezia,
abdominal pain, tenesmus, and documented urinary tract
infections. She could not recall an episode of rash or fever
(representing Katayama fever). Physical examination and
laboratory studies were normal, except for significant persistent
eosinophilia of up to 2,200 cells/mL. Serology tests
(immunoblot and FAST enzyme-linked immunosorbent assay [ELISA]
in-house tests; Centers for Disease Control and Prevention)
for Schistosoma mansoni were positive. Ultrasonography
study of the abdomen was normal. Repeated stool
examinations for ova were negative, and colonoscopy study was
normal. Direct examination of rectal snip and terminal ileum
biopsies were negative for ova, and pathology showed normal
mucosa. Praziquantel was administered without side effects.
Peritoneal schistosomiasis is a rare, albeit under-reported
phenomenon, which has been described with all three species
of the parasite. It can be asymptomatic, like in the case
presented, or cause ascites, weight loss, constipation, and
infertility.1 Ova can reach the peritoneum by migration through the
vessel wall or bloodstream embolization. Invasion can also
occur through the fallopian tubes in cases of genital
schistosomiasis.2 Ova located on the serosal side of the small bowel,
especially with the absence of any pathology in the mucosal
side of both the small bowel and the rectum, is unique.