This study evaluates 216 patients with schistosomal colonic disease, diagnosed by endoscopic biopsies at the Armed Forces Hospital, Riyadh. The colonoscopic appearance was suggestive of schistosomiasis in 98 of these patients (45.37%), Schistosoma mansoni ova in stool was detected in only 24 of these 216 patients (11-11%). The most common histopathological finding in colonic biopsies of these patients was Schistosoma mansoni ova in the colonic mucosa with no or mild inflammatory celis infiltrates. These findings correlate with the endoscopic appearances in most

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Six patients with a ruptured Echinococcus liver cyst were treated by means of endoscopy. The treatment consisted of endoscopic sphincterotomy, cyst material extraction and hypotonic saline lavage via a nasobiliary catheter. In five patients successful complete endoscopic treatment was achieved, including removal of daughter cysts. In the sixth patient only partial treatment could be performed with clearance of daughter cysts since there was no communication with the main liver cyst. Follow-up ultrasonography, CT and ERCP in all patients showed complete cure and no evidence of disease recurrence in five of them. The sixth patient required surgery one month after endoscopic treatment of the acute biliary obstruction.

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A case of a blue rubber bleb nevus syndrome in a 19-year-old female patient with multiple cutaneous and gastrointestinal hemangiomata is described. Recurrent GI bleeding resulted in severe chronic anemia, which was successfully treated by endoscopic laser photocoagulation and surgical resection. Both forms of therapy had to be repeated 4 years later, the patient having been well in the meantime. This combined endoscopic and surgical approach might also improve the survival of patients with severe GI hemorrhage due to blue rubber bleb nevus syndrome.

Previous reports showed that surgery is the only method of treating liver hydatid cysts that have ruptured into the biliary system. We report a case of obstructive jaundice due to spontaneous rupture of a liver hydatid cyst into the biliary system, which was treated non-surgically by endoscopic papillotomy and extraction of daughter cysts from the biliary system, insertion of a nasobiliary tube for drainage and injection of scolicidal hypertonic saline, into the biliary system. Clear resolution of the obstruction, disappearance of daughter cysts and a decrease in the size of the hepatic cyst was shown by ERCP, ultrasound and CT scan. We believe that this new method is safe, effective and has a lower incidence of mortality, morbidity and recurrence than surgery, which it should replace whenever possible.

A Saudi man underwent repeated percutaneous aspiration of a pleural effusion before a pleural biopsy showed hydatid disease. Subsequent investigations confirmed hydatid disease in the pleura and liver. The patient underwent surgical evacuation and irrigation of the pleural cavity followed by medical treatment for the liver cyst with albendazole, with complete recovery and disappearance of the liver cyst. The pleural cysts were enucleated and the pleural cavity was instilled with 05% silver nitrate. There was no communication through the diaphragm with the hepatic cyst and the surgeon did not attempt to remove the liver cyst because of the patient's general condition.The patient was treated with albendazole 400 mg twice daily for four weeks followed by two weeks without treatment and a further seven courses of albendazole over one year.Follow up with computed tomography and ultrasound showed regression and almost complete disappearance of the liver cyst and serial hydatid antibody titres showed a progressive fall from 1/8192 to 1/32 (negative) after one year. Forty two months after treatment the patient remained well with no recurrence of the pleural effusion.

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.