Management and treatment of decompensated hepatic fibrosis and severe refractory Schistosoma mansoni ascites with transjugular intrahepatic portosystemic shunt

Abstract

This study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension.

Insights on the Pathophysiology of the Progression to Decompensated Hepato-Splenic Schistosomiasis

“…Unlike liver cirrhosis, hepatosplenic schistosomiasis (HSS) has no gross loss of hepatocytes or nodular regeneration. Additionally, portal hypertension due to HSS has an important splenic venous hyper flow component contributing to the remaining preserved underlying hepatic function, and hepatic encephalopathy, ascites, and liver failure are uncommon 5 . Patients with hepatic schistosomiasis usually tolerate episodes of acute variceal bleeding better than patients with cirrhosis because of their preserved liver function.…”

Comportamento epidemiológico da doença de Chagas no Brasil: impactos e perspectivas para prevenção da transmissão oral

“…As parasitoses consistem em importantes doenças parasitárias cuja etiologia é diversa, não se restringindo exclusivamente a uma única causa. Dentre as doenças parasitárias, algumas se destacam pelo seu potencial de transmissão, virulência e patogenicidade, a exemplo da leishmaniose, doença de chagas, esquistossomose e malária (Almeida et al, 2021;Santo et al, 2022;Mazumder & Lee, 2022).…”

“…Dentre as doenças parasitárias, algumas se destacam pelo seu potencial de transmissão, virulência e patogenicidade, a exemplo da leishmaniose (Conde et al, 2022), doença de Chagas (Almeida et al, 2021), esquistossomose (Santo et al, 2022) e malária (Mazumder & Lee, 2022).…”