Perforation of small bowel caused bySchistosoma japonicum: A case report

Abstract

A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz's ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum.

Jejunal Ulcer Caused by Schistosoma japonicum

“…Schistosomiasis is considered the third most devastating tropical disease in Africa, South America, the Caribbean, Middle East, and Asia [6, 7]. The 2015 death estimates due to schistosomiasis need to be reassessed, as they vary between 24,067 and 200,000 globally per year [8].…”

Acute abdomen and schistosomiasis: A letter to the editor

“…Similarly, there have been cases around Pathology International 2016; 66: 596-597 doi:10.1111/pin.12452 the world presenting as intestinal perforation with a concurring schistosome infection. 5 Thus, it has been established that schistosome infections may have a negative influence on coagulation, but the exact mechanism of the organism preventing thrombus formation is not fully understood. 4,5 Nevertheless, it has been suggested in multiple studies that systemic effects occur, not because of the presence of adult schistosome in the veins, but due to their ovum inducing an immunological granulomatous reaction.…”

“…5 Thus, it has been established that schistosome infections may have a negative influence on coagulation, but the exact mechanism of the organism preventing thrombus formation is not fully understood. 4,5 Nevertheless, it has been suggested in multiple studies that systemic effects occur, not because of the presence of adult schistosome in the veins, but due to their ovum inducing an immunological granulomatous reaction. 4,5 This was evident in our case, where granulomatous reactions were systematically observed around the ovum along with signs showing active inflammation.…”

“…4,5 Nevertheless, it has been suggested in multiple studies that systemic effects occur, not because of the presence of adult schistosome in the veins, but due to their ovum inducing an immunological granulomatous reaction. 4,5 This was evident in our case, where granulomatous reactions were systematically observed around the ovum along with signs showing active inflammation. In our case, there was no apparent previous history or family history of any known medical or hereditary conditions that can be considered as risk factor for vascular occlusion and thrombus formation and no drug intake of any kind.…”

“…This is by the mechanical disruption of the ovum to the endothelium and/or by the immunological effect of the systemic infection causing an increase in the coagulation in the vessels. 5 This also leads us to hypothesize that the stage of infection and amount of ovum deposited may be risk factors for thrombus formation after schistosomiasis infection. In addition, hepatic fibrosis and scarring with consequence portal hypertension might also have contributed to vascular (particularly venous) stasis and subsequent thrombosis.…”