Hepatic Encephalopathy in Patients With Hepatosplenic Schistosomiasis Mansoni

Arch Surg. 1984;119(6):739. doi:10.1001/archsurg.1984.01390180099018.
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To the Editor.—Obeid et al1 commented that patients with schistosomiasis are better able to withstand the stress of hemorrhage and have a lower incidence of hepatic encephalopathy, since they retain hepatic cellular integrity and are younger than cirrhotic patients. However, there is evidence that esophageal variceal hemorrhage and the presence of a portacaval shunt of the collateral circulation for portal hypertension plays an important part in schistosomotic hepatic encephalopathy.2

It can be said that hemorrhage represents the most important cause of hepatic encephalopathy in patients with schistosomiasis,3 and, contrary to cirrhosis, one of the characteristics of hemorrhage in the hepatosplenic form of schistosomiasis is its tendency to recur.3 Although apparently well tolerated by many patients, these hemorrhagic episodes contribute to the formation and absorption of large quantities of ammonia, and reduce hepatic blood flow, which in turn leads to ischemic parenchymatous lesions with temporary or


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