Hepatosplenic Schistosomiasis
Hepatosplenic schistosomiasis is a consequence of a fibrotic reaction around egg granulomas in the liver, and an associated enlargement of the spleen (splenomegaly). This may occur as soon as 18 months after a heavy infection, or as long as 20 years in light infections. Here fibrosis in the granuloma leads to a so-called "Pipe stem Portal Fibrosis" as the inflammatory response spreads to portal blood vessels proximal to pre-sinusoidal vessels containing trapped eggs. These fibrotic reactions in turn lead to cirrhosis of the liver. This results in portal hypertension as blood flow through the liver is inhibited. At this point Ascites (an accumulation of fluid in the abdominal cavity) is common. The Portal Hypertension in turn eventually results in enlargement of hepatic arteries, which send out new collateral blood vessels, particularly oesophageal varisces. At this point recovery from the course of the disease may be irreversible due to the liver damage. The varisces may then rupture, resulting in massive blood loss, haemorrhagic shock and death, or alternatively the patient may suffer repeated episodes of variceal bleeding before succumbing.