SHUNT SURGERY FOR PORTAL HYPERTENSION DUE TO SCHISTOSOMA MANSONI

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Abstract
Communication between the portal vein and the vena cava was established surgically in 31 patients to relieve portal hypertension and hemorrhage from esophageal varices after infestation with Schistosoma mansoni. The remaining 10 patients underwent operations of other types, including splenorenal shunt in seven cases, but this operation has been discontinued. Liver biopsies were obtained in every instance at operation, and the nature of the infestation was confirmed by rectal biopsy, fecal examination, and skin testing. Of the 38 patients in whom the venous shunt surgery was successful, all have remained free from esophageal bleeding. It has been objected that such venous shunts open a direct passage for parasitic ova from the intestine to the lungs and so predispose to later development of pulmonary hypertension. This risk must be weighed against the more immediate danger that the unoperated patient may die of exsanguination due to bleeding esophageal varices.

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