Dilated Portal Vein Research Articles

Treatable fluctuating mental impairment in a patient with Bardet–Biedl syndrome

Bardet–Biedl syndrome (BBS) is an autosomal recessive disorder characterized by rod–cone dystrophy, polydactyly, central obesity, mental retardation, and hypogonadism. Although many organs are involved in BBS, hyperammonemia caused by portal hypertension has been reported previously in only a single patient. We describe the second such patient with BBS and hyperammonemia, associated with fluctuating mental impairment. The patient was a 17-year-old boy with BBS. Esophageal, gastric, and rectal varices and mild hepatic dysfunction started to develop at 5 years of age. A liver biopsy showed dilated portal veins with mild fibrosis in portal tract. From the age of 17 years, he often had forced laughter with apparently normal consciousness. Laboratory examinations revealed hyperammonemia (112.2 mg/ml). Oral medication lowered the blood ammonia level to 69.9 mg/ml, reduced the frequency of forced laughter, and improved his IQ. Patients with BBS may have additional diseases or conditions that affect mental status, such as hyperammonemia. Physicians should explore the underlying causes of these conditions and treat such patients, who already have a compromised quality of life.

Evidence of Liver Histological Alterations in Apparently Healthy Individuals Evaluated for Living Donor Liver Transplantation

Background Living donor liver transplantation (LDLT) represents an important therapeutic option for patients with end-stage liver disease (ESLD). It has been reported that steatosis may be a serious problem in patients who donate a part of their liver. Liver biopsy represents an accepted method to assess the rate of steatosis and the possible risk to the donor. Nonetheless, some histological abnormalities have been documented in the specimens from potential donors. The aim of this study was to evaluate the possible hepatic histological alterations among apparently healthy candidates for liver donation who did not show serological or ultrasound (US) evidence. Materials and Methods From January 1, 2005 until October 15, 2006, we performed virological, biochemical, and tumor marker evaluations and liver biopsies on 20 LDLT donor candidates. At histological evaluation we classified the evidence of steatosis (5%–10% or 10%–20%), fibrosis (absent or 1–3 portal space), inflammation, iron deposition, biliary neoductulation, and portal vein vascular alterations. Results Among the 20 subjects, serological markers did not show any pathological alterations. At liver biopsy we found: steatosis (5%–10%) in 6 individuals (about 30%) with 1 ranging from 10% to 20%; iron deposition in 4 (20%); biliary neoductulation in 3 (about 16%); fibrosis in 4 (20%); inflammation in 5 (25%); and portal vein dilatation in 10 (50%). Conclusions Our data showed that apparently healthy individuals who did not display serological markers or US evidence of pathology had liver histological abnormalities. This result suggested that in absence of clinical or laboratory alterations, liver biopsy may represent a useful diagnostic tool for living donor candidates. Long-term follow-up results for the laboratory data among those patients should be performed even though they were not qualified for LDLT.

Schistosoma mansoni morbidity among adults in two villages along Lake Victoria shores in Mwanza District, Tanzania

The study aimed to describe morbidity patterns due to intestinal schistosomiasis in adults living in two villages along the southern shores of Lake Victoria, Mwanza District, Tanzania. Nine hundred and fifty persons from Msozi and 497 from Sangabuye, aged between 14 and 87 years, were examined by abdominal ultrasound according to the Niamey protocol. Liver image patterns (LIP) A and B were considered normal and C-F as distinct periportal fibrosis (PPF). The frequency of PPF was higher in Msozi (41.5%) than in Sangabuye (16.7%) (P<0.001) and was associated with high prevalence and intensity of Schistosoma mansoni infection. PPF was shown to be more common in males than females. Abnormal increase of segmental branch wall thickness (SBWT) and dilated portal vein diameter (PVD) were also more common among males than females. Hepatomegaly and splenomegaly were frequently encountered in both villages. The LIPs were positively correlated to size of SBWT and PVD but not to size of left liver lobe or spleen. In the study communities the risk of developing PPF differed greatly among individuals depending on various risk factors especially alcohol consumption.

Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats

To explore the influence of portal vein hemo-dynamic changes after portal venous arterialization (PVA) on peribiliary vascular plexus (PVP) morphological structure and hepatic pathology, and to establish a theoretical basis for the clinical application of PVA. Sprague-Dawley rats were randomly divided into control and PVA groups. After PVA, hemodynamic changes of the portal vein and morphological structure of hepatohilar PVP were observed using Doppler ultrasound, liver function tests, ink perfusion transparency management and three-dimensional reconstruction of computer microvisualization, and pathological examination was performed on tissue from the bile duct wall and the liver. After PVA, the cross-sectional area and blood flow of the portal vein were increased, and the increase became more significant over time, in a certain range. If the measure to limit the flow in PVA was not adopted, the high blood flow would lead to dilatation of intrahepatic portal vein and its branches, increase in collagen and fiber degeneration in tunica intima. Except glutamic pyruvic transaminase (GPT), other liver function tests were normal. Blood with a certain flow and oxygen content is important for filling the PVP and meeting the oxygen requirement of the bile duct wall. After PVA, It is the anatomic basis to maintain normal morphology of hepatohilar bile duct wall that the blood with high oxygen content and high flow in arterialized portal vein may fill PVP by collateral vessel reflux. A adequate measure to limit blood flow is necessary in PVA.

Intrahepatic Cholangiocarcinoma with Old Infestation of Schistosoma japonicum: Report of a Case

We report a rare case of intrahepatic cholangiocarcinoma associated with old infestation of Schistosoma japonicum. The patient was a 76-year-old Japanese man who had lived his childhood in an endemic area of this parasite. He presented with jaundice and computed tomography showed a 4-cm, hypodense tumor in segment VIII of the liver. Microscopically, the resected mass was composed of well-differentiated adenocarcinoma cells. Fibrosis and inflammation were seen around the dilated peripheral portal veins embolized with dead S. japonicum eggs. Our search of the literature found only one other case of cholangiocarcinoma coincident with S. japonicum, suggesting that it is not a risk factor for cholangiocarcinoma, although the inflammation and fibrosis caused by the S. japonicum eggshells may predispose to carcinogenesis. However, there is no evidence supporting this hypothesis. More data are necessary to evaluate the differences in clinicopathological findings between cholangiocarcinoma concomitant with S. japonicum and the usual type of cholangiocarcinoma.

Hepatoportal Sclerosis as a Cause of Noncirrhotic Portal Hypertension in Patients With HIV

Hepatoportal sclerosis (HPS) is a cause of noncirrhotic portal hypertension, with patients typically presenting with variceal bleeding. It is idiopathic in nature but is felt to be due to an abnormality of the intrahepatic vasculature. HPS is characterized by varying degrees of portal fibrosis, sclerosis of portal vein branches and dilatation of sinusoidal spaces. Nodular regenerative hyperplasia (NRH), another cause of noncirrhotic portal hypertension, has also been recently described in HIV patients initially diagnosed as having cryptogenic liver disease. We describe four cases of HIV+ patients presenting with noncirrhotic portal hypertension; liver biopsies were reviewed by an experienced liver pathologist and found to be consistent with HPS. No other etiologies for their liver disease were found. HPS has been recently identified as a cause of noncirrhotic portal hypertension in patients with HIV. It should be considered in the differential diagnosis of HIV patients presenting with variceal bleeding. We postulate that it may be due to intrahepatic microthrombosis or an altered hepatic fibrogenesis related to highly active antiretroviral therapy or due to HIV itself.

Pimelea trichostachya poisoning (St George disease) in horses

A dense population of Pimelea trichostachya plants (Family Thymelaeaceae) in pasture poisoned a horse herd in southern inland Queensland in October-November 2005. Plant density was 2 to 45 g wet weight/m(2) (mean 16 g/m(2)) from 5 to 69 plants/m(2) (mean 38 plants/m(2)) representing 3 to 20% (mean 9%) of the volume of pasture on offer. Ten of 35 mares, fillies and geldings were affected. Clinical signs were loss of body weight, profound lethargy, serous nasal discharge, severe watery diarrhoea and subcutaneous oedema of the intermandibular space, chest and ventral midline. Pathological findings were anaemia, leucocytopenia, hypoproteinaemia, dilatation of the right ventricle of the heart, dilated hepatic portal veins and periportal hepatic sinusoids (peliosis hepatis), alimentary mucosal hyperaemia and oedema of mesenteric lymph nodes. Cattle grazing the same pasture were affected by Pimelea poisoning simultaneously. Removal of the horses to Pimelea-free pasture initiated recovery. The one other incident of this syndrome, previously only recognised in cattle in Australia, occurred in horses, in South Australia in 2002, with access to a dense Pimelea simplex population.

Osler-Weber-Rendu Disease with Esophageal Varices and Hepatic Nodular Change

A 72-year-old male visited our hospital for further evaluation of esophageal varices. Telangiectasias were present in the stomach. He had recurrent epistaxis, which was also confirmed in his family's medical history. We diagnosed this case as Osler-Weber-Rendu disease. He had concomitant with hepatic nodular change. Abdominal angiography showed arterio-portal (A-P) shunts, superior mesenteric artery (SMA)-superior mesenteric vein (SMV) shunt, extension of SMV, and dilated and meandering portal vein. Esophageal varices were treated by endoscopic variceral ligation (EVL) and argon plasma coagulation (APC) therapy for prophylaxis of bleeding.

ASSESSMENT OF ULTRASOUND MORBIDITY INDICATORS OF SCHISTOSOMIASIS IN THE CONTEXT OF LARGE-SCALE PROGRAMS ILLUSTRATED WITH EXPERIENCES FROM MALIAN CHILDREN

We assessed morbidity indicators for both Schistosoma haematobium and Schistosoma mansoni infections and evaluated the appropriateness of the World Health Organization (WHO) guidelines for ultrasound in schistosomiasis in the context of large-scale control interventions. Abdominal and urinary tract ultrasonography was performed on 2,247 and 2,822 school children, respectively, from 29 randomly selected schools in Mali before the implementation of mass anthelminthic drug administration. Using two-level logistic regression models, we examined associations of potential factors with the risk of having a positive ultrasound global score (morbidity indicative of S. haematobium infection), abnormal image pattern scores, dilatation of the portal vein, and/or enlarged liver (morbidity indicative of S. mansoni infection). The WHO protocol was found useful for detection of S. haematobium pathology but overestimated the risk of portal vein dilatation and left liver lobe enlargement associated with S. mansoni infection. We conclude that ultrasonography should be included in large-scale control interventions, where logistics allow, but cautiously.

Arterioportal Fistula Causing Pancreatic Insufficiency

Purpose: Arterioportal fistulas may be asymptomatic or present with clinical syndromes, including portal hypertension, heart failure, ascites and intestinal ischemia. There are no reports of pancreatic insufficiency from arterioportal fistulas. Arteriovenous fistulas often lead to altered blood flow to end organs resulting in a “steal syndrome.” The decreased perfusion to organs can result in ischemic effects on the end organs, such as ischemic colitis. We present a case of a patient who presented with pancreatic insufficiency secondary to an arterioportal fistula. A 36-year-old gentleman presented with diarrhea, epigastric pain and weight loss. After noting progressive weight loss of 30 lbs over the past year, he was referred to gastroenterology. He denied alcohol use or a family history of pancreatic disease. His medical history was remarkable for abdominal surgery twelve years prior to repair a gunshot wound to the right flank. Upper endoscopy and colonoscopy, including biopsies, were normal. Laboratory analysis, including amylase, was normal. Stool analysis revealed no ova or parasites; however, the sudan stain for fecal fat was positive. A dynamic, contrast enhanced CT scan of the abdomen revealed profoundly decreased flow into the pancreas, ascites and a markedly dilated portal vein. The enhancement was similar to that seen in necrotizing pancreatitis. However, the border of the pancreas was intact with no stranding of the peri-pancreatic peritoneum. Angiography revealed common hepatic artery, gastroduodenal artery and inferior pancreaticoduodenal artery fistulae to the portal vein. In order to reverse the flow, a selective arterio-embolization was performed. GD Coils were placed to occlude both fistulae. The symptoms quickly improved with resolution of pain and diarrhea. Repeat CT-scan revealed a decrease in the early filling of the portal vein and absence of previous filling defect of the pancreas. Our patient was discharged and remains well. This case represents the identification and successful treatment of a patient with a pancreatic steal syndrome not previously reported in the literature. This pancreatic steal syndrome presented as a sequela of a rare arterioportal fistula supplied from both the celiac and superior mesenteric arterial axis. A minimally invasive technique resulted in resolution of the fistula, abnormal pancreatic imaging and symptoms.

Focal hepatic lesions mimicking cavernous hemangioma supplied by the portal vein

We report that imaging findings of focal hepatic lesion mimicking cavernous hemangioma supplied by the portal vein, which showed delayed enhancement on CT and hyperintensity similar to that of cerebrospinal fluid on T2-weighted MR images. Biopsy specimen showed the dilated portal veins and hyperplastic change in the surrounding liver parenchyma. CT during arterial portography (CTAP), in particular single-level dynamic CTAP, could clearly depict the abnormal dilated portal vein in the lesion and facilitated the diagnosis of this condition.

3035: Hemodynamic evaluation with Doppler sonography in mansoni schistosomiasis: A field study in areas of high, medium and low endemicity

Objectives: To evaluate the hemodynamic behavior of the portal system in mansoni schistosomiasis using the Doppler sonography in endemic areas of high, medium and low endemicity Methods: A total of 574 ultrasound exams were performed (Mode B and Doppler). The liver, spleen, gallbladder, portal vein and its bifurcation, splenic, superior mesenteric and supra-hepatic veins, splenic and hepatic arteries were studied. Results: In the preliminary analyses, the main findings in the different areas were: peri-portal thickness (48,5%; 14%; 4,5%), splenomegaly (15%; 5%; 2%) and portal vein dilatation (11,5%; 7%; 4,5%). Collateral circulation (4,8%) and portal vein thrombosis (1%) were found only in the high endemicity area. The average of maximum portal vein velocity was 22 cm/s, the hepatic artery systolic peak velocity was 80 cm/s and its resistive index was 0.7 (values among the three areas). Conclusions: This field study confirmed the broad majority of mild forms of mansoni schistosomiasis, and presented alteration indexes quite lower than those performed in hospital settings. Doppler is a viable method for research under field conditions and proved to be a useful tool for identifying collateral vessels and portal vein thrombosis. The Doppler velocimetry values were in the normal range even in patients with severe periportal fibrosis.

An Unusual Cause of Portal Hypertension

52 year old male with a history of lymphoma and prior chemotherapy (4 yrs ago)presented with new onset ascites. He also had splenectomy as part of staging for lymphoma. Physical exam revealed moderate ascites, jugular venous distension, bilateral lower extremity edema and hemocult positive stool. Liver Function tests: serum albumin 4.2gm/dl ALT 34 I U/L, AST 36 IU/L, total bilirubin 1.1 mg/dl. Serum creatinine and electrolytes were normal. Bone marrow was normal with no recurrence of lymphoma. Ascitic fluid showed albumin of 2.3 mg/dl, with negative cytology. Ascitic fluid LDH, amylase and bilrubin were normal. Ascites with a serum albumin ascitic fluid gradient (SAAG) greater than 1.1, led to the following investigations for the etiology of portal hypertension (Portal HTN). Doppler ultrasound of the liver showed dilated main portal vein with forward flow in the right and left branches. Hepatic veins were patent with appropriate wave forms. A triple phase CT scan showed prominent portal vein. Echocardiogram showed normal left ventricular function and normal sized chambers. Estimated PA pressure was 25 mm Hg. Upper endoscopy was significant for portal gastropathy with no esophageal or gastric varices. A transjuguar liver biopsy showed normal hepatic histology. Trichrome and reticulin stains showed absence of fibrosis with normal architecture. Pressure measurements obtained at the time of liver biopsy were as follows: Suprahepatic inferior venacava 4 mmHg, free hepatic vein 6 mmHg and wedge pressure 14mmHg. Hence this patient had clinical manifestations of portal hypertension such as ascites, dilated portal vein and high SAAG, but lacked any specific explanation as he had normal liver biopsy and a normal gradient across the hepatic vein and the sinusoids. Because of the prior history of splenectomy and lack of any other specific etiology we performed a celiac axis angiogram. This showed a splenic artery and venous fistula, near the site of ligation of splenic artery. The fistula was succesfully embolized with resolution of patient's ascites. Splenic arterovenous fistulas (SAVF) are extremely uncommon causes of portal HTN. Most often patients present with gastrointestinal bleeding. History of splenectomy and normal gradient across the hepatic vein and the sinusoids prompted us to do an angiogram. It is important to diagnose this entity as prolonged exposure to high flow in portal vein can ultimately lead to portal fibrosis and cirrhosis.

Percutaneous Transhepatic Balloon Dilation of Portal Venous Stenosis in Patients with Living Donor Liver Transplantation

To retrospectively evaluate the long-term effectiveness of percutaneous transhepatic balloon dilation of portal venous stenosis in patients who have undergone living donor liver transplantation. Institutional review board approval and informed consent were not required. From June 1996 to August 2003, obstructed portal venous blood flow was diagnosed in 45 patients (21 male, 24 female) with a history of living donor liver transplantation; patients ranged in age from 9 months to 61 years (mean, 9.2 years). All stenoses occurred in the extrahepatic portal vein near the anastomosis of the portal vein. All dilation procedures were performed with percutaneous transhepatic puncture of the intrahepatic portal vein and subsequent balloon dilation of the stenosis. Patients who experienced recurrent stenosis underwent another balloon dilation session. Intravascular metallic stents were not deployed because of the possible need for repeated transplantation. The authors used paired t tests to compare patients successfully treated with one venoplasty procedure and those requiring repeated venoplasty, with regard to age and stenosis diameter percentages before and after the initial procedure. Percutaneous balloon dilation was technically successful in 35 of 45 patients. In the remaining 10 patients, portal venous thrombotic occlusion precluded access to the mesenteric side of the portal vein. Twenty-five patients were successfully treated with a single session of balloon dilation (group 1). Results at follow-up ultrasonography revealed restenosis in 10 of 35 patients. Recurrent stenosis was resolved by means of repeated balloon dilation in nine patients (group 2). There were no significant differences between groups 1 and 2 in age (P = .87) or in stenosis diameter percentages before (P = .053) or after (P = .95) the initial procedure. Percutaneous transhepatic balloon dilation seems to be an effective method for treatment of portal venous stenosis after living donor liver transplantation.

Aneurysmal dilatation of the portal vein: A rare cause of portal hypertension

Aneurysmal dilatation of the portal vein (ADPV) is a rare cause of portal hypertension. We described a case of ADPV in a female patient who presented with ascites. Imaging studies revealed tortuosity and dilatation of the main portal vein with turbulent flow. Endoscopy revealed oesophageal varices. A liver biospy showed no abnormalities in liver histology. This is the first case of ascites as a complication of ADPV in the absence of liver cirrhosis, arteriovenous fistula or documented portal vein thrombosis. Hyperdynamic circulation and increased portal vein flow could be implicated in the pathogenesis of ascites in this setting.

Portal Vein Dilatation in The Liver Transplant Recipient

Portal vein stenoses are quite rare in liver transplant recipients except when interposition grafts are used to facilitate the surgical anastomosis.1 Often these lesions are discovered with non-invasive screening tests such as ultrasound but can also present with symptoms related to portal hypertension. Because stenoses can progress to complete occlusions that portend a much worse prognosis, we have aggressively sought and dilated stenoses. When encountered, this type of vascular complication is effectively alleviated with percutaneous angioplasty.2,3,4,5,6 Metallic stents have also been used effectively to treat recurrent and elastic stenoses.6,7,8

A Simple and Effective Method to Improve Intrasplenic Rat Hepatocyte Transplantation

Transplanted hepatocytes integrate, survive, and express their specific functions in the liver parenchyma. The aim of this study was to determine whether a large number of hepatocytes could move from the spleen to the liver when the cells are injected together with sodium nitroprusside, and if the improved hepatocyte migration may be related with portal vein dilatation. Wistar rats were transplanted in the spleen with fluorescent-labeled hepatocytes alone or together with sodium nitroprusside. At 1, 3, 6, and 24 h after the transplant, the liver from recipient animals was removed and morphometric analyses were performed. Portal and arterial pressures were also measured immediately after intrasplenic injection of a solution of sodium nitroprusside, hepatocytes alone, or hepatocytes plus sodium nitroprusside. Intrasplenically injected sodium nitroprusside produced a transient drop in arterial pressure and a sustained reduction in portal pressure. During hepatocyte transplantation it increased the number of transplanted cells migrating to the liver after 3 h. Sodium nitroprusside simultaneously injected with hepatocytes in the spleen allowed more cells to migrate into the liver of the host animal without risk in animal survival.

Doppler ultrasonographic grading of hepatic vascular malformations in hereditary hemorrhagic telangiectasia -- results of extensive screening.

In previous studies, the prevalence of hepatic vascular malformations (VMs) in a large Italian family with hereditary hemorrhagic telangiectasia (HHT) was examined by Doppler ultrasonography (US) as screening technique, and the relevant Doppler US findings were described and classified. Thereafter, Doppler US has been routinely used to screen HHT families for liver involvement. Hepatic VMs were evaluated and classified on the basis of Doppler US findings. Three hundred and forty-six subjects belonging to 64 pedigrees were checked for the presence of signs of HHT. All of them underwent abdominal Doppler US screening for hepatic VMs. Vascular abnormalities were classified as minimal if the hepatic artery was dilated in extrahepatic tract only and measured > 6 mm; as moderate if the hepatic artery was dilated in both intra and extrahepatic tract; and as severe if complex changes of the arterial hepatic branches were associated with hepatic and/or portal vein dilatation. Furthermore, Doppler parameters, both qualitative (flow direction, turbulence) and quantitative (peak flow velocity and resistivity index in hepatic artery, mean velocity in portal vein, diastolic peak flow velocity in hepatic veins), were entered into our VM classification. HHT was found in 222 subjects, with hepatic VMs detected by Doppler US in 92 (41.4 %) (24 males, 68 females, mean age 52.2). Hepatic VMs were minimal in 11 subjects, moderate in 70, and severe in 11. On the basis of our proposed grading, hepatic VMs can be easily classified in subjects with HHT by Doppler US. Depending on the degree of hepatic vascular derangement, appropriate programs for follow up and/or therapy can be designed.

A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils

Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13-14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included.

Epidemiological and morbidity assessment of Schistosoma japonicum infection in a migrant fisherman community, the Dongting Lake region, China

We assessed the epidemiology and morbidity related to Schistosoma japonicum infection by both parasitological (Kato-Katz method and miracidium hatching test) and ultrasound examination in a migrant fisherman community ( n = 106) from the Dongting Lake region in China in 2001. A prevalence of 69.8% and a mean infection intensity of 66.5 eggs per gram (epg) were recorded for this group. Males had a higher level of infection (77%) and intensity (92.2 epg) compared with females (58% and 28.6 epg, respectively). Subjects aged 11–20 years had the highest prevalence of infection (91%) and the heaviest infection intensity (85.3 epg) among all age groups. Twenty-six percent of the subjects had not been treated previously for schistosomiasis. Parenchymal fibrosis (⪖ stage II) detected by ultrasound and spleen enlargement (or splenectomy) occurred in 37% and 9% of subjects, respectively. Portal vein dilation was detected in 18% subjects, and 58% ( 11 19 ) of those patients with portal vein enlargement were shown to have parenchymal fibrosis (⪖ stage II). These results indicate that S. japonicum infection and related morbidity in mobile fishermen is still unacceptably high despite the fact that China has implemented a Schistosomiasis Control Project financed by a World Bank Loan for a period of 8 years since 1992. Clearly, new approaches for schistosomiasis control, especially in communities like these mobile fishermen, should be explored.