Severe liver fibrosis caused by Schistosoma mansoni : management and treatment with a transjugular intrahepatic portosystemic shunt

• Published in: The Lancet infectious diseases 2015-06, Vol.15 (6), p.731-737
• Main Authors: Richter, Joachim, Prof, Bode, Johannes G, MD, Blondin, Dirk, MD, Kircheis, Gerald, MD, Kubitz, Ralf, MD, Holtfreter, Martha C, PhD, Müller-Stöver, Irmela, MD, Breuer, Matthias, MD, Hüttig, Falk, MD, Antoch, Gerald, MD, Häussinger, Dieter, MD
• Format: Article
• Language: English
• Subjects: Animals; Autoimmune diseases; Bile; Chemotherapy; Disease; Drug dosages; Family medical history; Gallbladder; Gastroenteritis; Guinea; Humans; Hypertension; Infections; Infectious Disease; Infectious diseases; Kinases; Liver; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - surgery; Mollusks; Morbidity; Portasystemic Shunt, Surgical - methods; Refugees; Schistosoma mansoni - isolation & purification; Schistosomiasis; Schistosomiasis mansoni - complications; Schistosomiasis mansoni - diagnosis; Toxins; Tropical diseases
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(15)70009-5

Summary Liver diseases are common in inhabitants and migrants of tropical countries, where the liver can be exposed not only to toxins but also to many viral, bacterial, fungal, and parasitic infections. Schistosomiasis—a common parasitic infection that affects at least 240 million people worldwide, mostly in Africa—is regarded as the most frequent cause of liver fibrosis worldwide. We present a case of a 19-year-old male refugee from Guinea with recurrent oesophageal variceal bleeding due to schistosomal liver fibrosis refractory to endoscopic therapy. This case was an indication for portosystemic surgery, which is a highly invasive non-reversible intervention. An alternative, less invasive, reversible radiological procedure, used in liver cirrhosis, is the placement of a transjugular intrahepatic portosystemic shunt (TIPS). After thorough considerations of all therapeutic options we placed a TIPS in our patient. In more than 3 years of observation, he is clinically well apart from one episode of hepatic encephalopathy related to an acute episode of viral gastroenteritis. Bleeding from oesophageal varices has not recurred. In this Grand Round, we review the diagnostic approaches and treatment options for portal hypertension due to schistosomal liver fibrosis.