Emergency surgical management for complicated schistosomal massive splenomegaly with portomesenteric thrombosis and bowel ischemia: a case report
Rasheed Altwiher, Ahmad Alzaid, Amir Othman, Yasser Alhabeeb, Mahabbah Fawaz Almarshdi, Yasmin Al-ShammariIntroduction:
Schistosomal periportal fibrosis is a major cause of non-cirrhotic portal hypertension and massive splenomegaly. Rarely, superimposed portomesenteric venous thrombosis (PMVT) may precipitate bowel ischemia. Managing this combination in non-endemic settings presents significant diagnostic and therapeutic challenges. We report successful bowel salvage and definitive portal decompression during the same surgical course.
Case presentation:
A 43-year-old man with schistosomal periportal fibrosis and massive splenomegaly presented with partial PMVT-associated bowel ischemia. Following surgeon-led MDT evaluation, emergency laparotomy revealed an ischemic jejunal segment, which was completely salvaged after extensive adhesiolysis relieved severe splenic mesenteric traction. Concurrently, splenectomy and esophagogastric devascularization successfully addressed the underlying portal hypertension. After a 48-hour damage-control temporary closure, a second-look confirmed bowel viability. A postoperative Grade B pancreatic fistula resolved conservatively. The patient recovered completely, with long-term variceal regression.
Conclusion:
Definitive surgical management can complement emergency intervention in selected patients with advanced hepatosplenic schistosomiasis. Successful outcomes require timely surgeon-led multidisciplinary decision-making and careful damage-control surgical planning.