José Roberto LambertucciI; Vivian ResendeII; Izabela VoietaI
IPós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil IIDepartamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
A 46-year-old male patient was admitted to hospital in October 2007 for surgical treatment of portal hypertension. He had been diagnosed with hepatosplenic Manson’s schistosomiasis eight years earlier, during an episode of digestive tract bleeding. On that occasion (1999), he was treated with praziquantel and underwent repeated sessions of sclerotherapy for esophageal varices. Despite this, he presented two additional episodes of bleeding due to rupture of esophageal varices. Upon hospital admission, hepatomegaly and splenomegaly were found (Figure A). During surgery, pseudo-nodules were identified on the liver surface (Figure B – black arrow). Abdominal magnetic resonance imaging showed portal vein thrombosis (Figure C – white arrows point to the thrombus – magnified in the inset) and periportal thickening (yellow arrows). The surgical procedure chosen was esophagogastric disconnection associated with splenectomy and suturing of the varices. Ten days after surgery, he was discharged from hospital in good clinical condition. Portal vein thrombosis is quite common (5% of our patients) in cases of hepatosplenic Manson’s schistosomiasis and is easily diagnosed by magnetic resonance imaging, before any surgical procedure.
REFERENCES
1. Lambertucci JR, Andrade LM, Pinto-Silva RA. Magnetic resonance imaging of the liver in hepatosplenic schistosomiasis mansoni. Revista da Sociedade Brasileira de Medicina Tropical 35:679-680, 2002. [ Links ]
2. Lambertucci JR, Serufo JC, Gerspacher-Lara R, Rayes AA, Teixeira R, Nobre V, Antunes CM. Schistosoma mansoni: assessment of morbidity before and after control. Acta Tropica 77:101-109, 2000. [ Links ]
3. Petroianu A. Surgical treatment of portal hypertension in schistosomiasis mansoni. Revista da Sociedade Brasileira de Medicina Tropical 36:253-265, 2003. [ Links ]
Address to:
Dr. José Roberto Lambertucci
Faculdade de Medicina/UFMG
Avenida Alfredo Balena 190
30130-100 Belo Horizonte, MG, Brasil
e-mail: lamber@uai.com.br
Recebido para publicação em 11/02/2009
Aceito em 05/03/2009
