Observations on Portal Hypertension among Schistosomiasis Patients with Relatively Insignificant Complaints

Abstract

Summary and Conclusions Forty-six active-duty soldiers, who were only recently well, were studied because of various abdominal symptoms and were found to have schistosomiasis mansoni or japonica in differing stages of chronicity. Splenomegaly was the only clinical sign pointing to portal hypertension, but endoscopic investigation revealed esophageal varices in seven and gastric varices in one. Treatment of schistosomiasis did not effect any important general change in the appearance of the varices or in the portal venous pressure. Two patients were treated by end-to-side portacaval shunt, with disappearance of the varices. It is concluded that schistosomal infection which is clinically mild may be accompanied by occult but important portal hypertension with esophageal varices. The danger of hemorrhage from unsuspected varices renders routine esophagoscopic study desirable in this infection. Portacaval or splenorenal shunt operations, as lienoportal venography may dictate, promise to be the most effective measures for treatment of varices secondary to schistosomiasis.