[Decompensated post-schistosomiasis portal hypertension in Richard-Toll, Senegal: first case treated by splenorenal anastomosis in Dakar].
Since the Diama dam on the Senegal river became operative in 1986, an exceptional outbreak of intestinal schistosomiasis occurred in northern Senegal. This is the first case report from this region of a splenorenal derivation performed in Dakar to cure decompensated portal hypertension due to Schistosoma mansoni.


METHODS
In June 1998, a 16-year old boy, native from Richard-Toll in the Senegal River Basin, was admitted to the paediatric department of Hôpital Principal, Dakar, Senegal, with a 3 years of recurrent hematemesis. Blood transfusions were required despite propranolol and multiple oesophageal varices sclerotherapies. On admission he weighed 33 kg and was noted to have pallor and moderate hepatosplenomegaly. Lab work included normal liver function tests, a Hgb of 58 mg/L, negative HBs antigen, and high titers of schistosomiasis antibodies (> 1/2000 by the hemagglutination method). Ultrasound revealed an homogeneously enlarged liver, periportal fibrosis and spleen with a grade 2 portal hypertension (WHO score). Endoscopy showed stage 3 oesophageal varices with red spots but no active haemorrhage. After transfusions, a Warren distal splenorenal anastomosis was performed. During the operation, a liver biopsy was obtained, showing periportal fibrosis and schistosomiasis granulomas. The patient was discharged without complication. After 4 years he remains free of any recurrence of his upper gastrointestinal haemorrhage and haemoglobin rate is normal.


CONCLUSIONS
Before the inauguration of the dam in 1986, S. mansoni infection was never reported from the Senegal River Basin. But as early as 1988, the first cases of intestinal schistosomiasis began to show up. A few years later, this focus had dramatically extended and in 1991 the first cases of hepatic fibrosis were detected in ultrasonography surveys. The present case involves the first patient from northern Senegal who required surgery for haemorrhagic complications of schistosomiasis induced by liver disease. Considering the high prevalence in this area, and the difficulties of medical management, the need for porto-systemic derivations is likely to rise. These operations are difficult and require specially trained surgeons. They have been largely unavailable in Senegal until now. This case report, involving a child only 10 years after the beginning of the epidemic, underlines the acute need for improving both prevention and medical treatment in order to avoid progression to clinical stages of hepatic schistosomiasis where surgery is unavoidable. In addition, the training of local surgical teams able to deal with these complications is urgently needed in Senegal.
Service de pédiatrie, Hôpital Principal, Dakar, Sénégal.
P
P
Imbert
P
P
Gérardin
A S
AS
Ka
J M
JM
Andreu
M
M
Cassagnou
F
F
Klotz
D000293:Adolescent; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood; D001803:Blood Transfusion; D004932:Esophageal and Gastric Varices / Q000469:parasitology; D006801:Humans; D006975:Hypertension, Portal / Q000469:parasitology* / Q000601:surgery*; D007668:Kidney; D008297:Male; D011170:Portasystemic Shunt, Surgical; D012550:Schistosoma mansoni / Q000276:immunology; D012555:Schistosomiasis mansoni / Q000150:complications*; D012675:Senegal; D013154:Spleen
D000909:Antibodies, Helminth