Aiming to get a better understanding on the pathogenesis of severe schistosomiasis mansoni in adults and children, the differences on the liver histopathology and the pattern of upper digestive endoscopy among these patients were studied, Twenty-one adults and equal number of children were included in this investigation. All patients underwent splenectomy and ligature of the left gastric vein. The pathological findings were assessed on the sections of wedge liver biopsy. The pathological findings in adults were Symmer’s fibrosis grades - I, in one; II, in seven; and III, in thirteen. Minimal inflammatory activity was observed in five, fair in seven, moderate in six and severe in one. Two patients showed no inflammatory activity. Minimal granuloma reaction was observed in four patients and moderare in two; fifteen had no such reaction. Minimal schistosomotic pigmentation was observed in four patients and moderare in one, howeve1; in sixteen patients, such pigmentation was not observed. in children, Symmer's fibrosis grade I was observed in one patient, grade II in four and grade III in sixteen. Minimal inflammatory reaction was observed in seven patients; and fair reaction in fourteen. Minimal granuloma reaction in six patients, fair in five, and moderate in two; in eight patients such reaction was not observed. Minimal schistosomotic pigmentation was observed in six patients, fair in three, moderare in six, and not observed in six patients. Upper digestive endoscopy showed the following results. Adults: medium size esophageal varices in eight (38%) patients, and large size in thirteen (62%). Varices in the pyloric part of the stomach were found in eight patients (38%), and five (24%) in the body. Portal hypertension gastropathy was seen in sixteen patients (76%). Children: four (19%) showed thin esophageal varices, eight (38%) medium size varices, and nine (43%) large size varices. Three (14%) patients showed gastric varices, two in the pyloric region and one in the body. Nine children (43%) showed portal hypertension gastropathy. From these results, the following conclusions can be drawn although the differences were not statistically significant: liver histopathology tended to be more evident in children, while hemodynamic portal hypertension repercussions were more severe in adults.
Shistosomiasis mansoni; Hepatosplenic schistosomiasis; Liver histopathology; Digestive endoscopy; Adults; Children