We present the preoperative findings of 102 patients who underwent successful
splenectomy for advanced
schistosomiasis japonica. All patients were symptomatic for
schistosomiasis and had
splenomegaly greater than or equal to II according to the Hackett criteria. Before surgery, all patients underwent clinical examination including full blood count;
fibrinogen and
serum protein levels; liver function tests; and serology for
hepatitis B, C, and D. Ultrasound examination of the liver and spleen and liver histology for evidence of pathology were also undertaken. Ninety patients had a treatment history for
schistosomiasis. Fifty-six patients were seropositive for hepatitis B virus antibody, and 6 patients were seropositive for hepatitis C virus antibody. Immunohistochemical testing of the liver samples confirmed that 45 patients were positive for hepatitis B virus
surface antigen, thereby indicating active
infection. A total of 66.7% of patients had
fibrosis stages II to III by ultrasound; and 76.5% of patients had portal vein inner diameter greater than 12 mm, indicating portal vein
hypertension. A total of 83.2% of patients showed various stages of esophageal varicosis via x-ray, and 81.4% had fibrotic stages III to IV by liver biopsy.
Coinfection with hepatitis B virus accelerated the development of
liver fibrosis. There was moderate concordance between the
fibrosis assessed by ultrasonography and histopathology, indicating that ultrasound underestimates the true pathology. Combined assessment is needed to improve the diagnosis of clinical hepatic
fibrosis.