This study aims to evaluate the anthelminthic effect of Balanities aegyptiaca fruit aqueous extract against Schistosoma mansoniin vivo. Parasitological aspects were determined to evaluate the antischistosomal activity of B. aegyptiaca. In addition, tegumental surface topography alterations of S. mansoni adult male worms were noticed via scanning electron microscopic (SEM) investigation after treatment the infected mice orally with 200 mg/kg body weight (BW) B. aegyptiaca alone or combined with 300 mg/kg BW Praziquantel (PZQ). Results showed that treatment of S. mansoni infected mice with B. aegyptiaca, PZQ, or in combination led to a significant decrease (P<0.05) in the weight of liver and intestine as compared with those of S. mansoni-infected mice. Meanwhile, administration of the B. aegyptiaca, PZQ, or in combination decreased significantly (P<0.05) the total worm burden and ova count/g in hepatic and intestinal tissue. B. aegyptiaca and/or PZQ showed a remarkable effect on the oogram pattern in liver and intestine, where the immature and mature eggs were significantly decreased (P<0.05); whereas, dead eggs were significantly increased (P<0.05). The electron microscopy observation exhibited swelling, vacuolization, fusion of the tegumental folds, and loss or shortening of the spines on the tubercles, erosion, cracks and peeling of S. mansoni adult male worm after treatment with B. aegyptiaca and/or PZQ. This study revealed that B. aegyptiaca has a remarkable antischistosomal activity through deteriorating action on the adult worm evidenced by scanning electron microscopy.