Surgical hepatosplenic schistosomiasis mansoni in children: a Doppler Duplex study of the portal vein and the hepatic artery

Abstract

From January 1990 to September 1993, 25 children with hepatosplenic schistosomiasis mansoni and oesophageal varices underwent splenectomy, ligature of the left gastric vein and autoimplantation of 100 g of spleen into the great omentum at the University Hospital, Recife, Brazil. The diameters and the blood flow velocities of the portal vein and the hepatic artery were measured before and after surgery. A Doppler Duplex (Aloka 680 ®) with a convex transductor of 3.5 MHz was used. Post-operative follow-up revealed (i) a significant decrease in the mean diameter of the portal vein from 12.6 ± 2.1 mm to 9.6 ± 1.9 mm, (ii) a significant increase in the mean diameter of the hepatic artery from 5.0 ± 1.4mm to 5.3 ± 1.2 mm, (iii) a significant decrease in the mean blood flow velocity in the portal vein from 31.1± 8.0 cm/s to 22.4 ± 7.1 cm/s, and (iv) no significant change in blood flow velocity in the hepatic artery. The study supports the concept that surgical treatment for portal hypertension in patients with hepatosplenic schistosomiasis mansoni, which includes splenectomy, results in a decrease of venous portal blood flow to the liver associated with an increase in the arterial hepatic blood flow. The physiological implications of these haemodynamic changes in the long term remain to be investigated.