title: Severe liver fibrosis caused by Schistosoma mansoni: management and treatment with a transjugular intrahepatic portosystemic shunt.
abstract: 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.
authors.affiliation: Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany. Electronic address: joachim.richter@med.uni-duesseldorf.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Richter
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Bode
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Blondin
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Kircheis
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Kubitz
authors.affiliation: Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Martha C
authors.initials: MC
authors.lastname: Holtfreter
authors.affiliation: Tropical Medicine Unit, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Irmela
authors.initials: I
authors.lastname: Müller-Stöver
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Breuer
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Hüttig
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000818:Animals; D016701:Guinea; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012036:Refugees; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012555:Schistosomiasis mansoni / Q000150:complications* / Q000175:diagnosis*