Laparoscopic diagnosis and clinical course of chronic schistosomiasis japonica

Laparoscopic findings of nine patients with chronic schistosomiasis japonica were analyzed and compared to hepatic ultrasonograms, computed tomography (CT) scans and histological findings from the same patients. In all nine patients laparoscopy revealed yellowish, small speckles, approximately 50 microm in diameter, sparse or clustered over the liver surface, which were later found to represent subcapsular calcified ova of Schistosoma japonicum. While the liver surface was almost smooth in mild schistosomiasis, multiple whitish markings and irregular, relatively wide, groove-like septums were seen in more advanced cases. In severe schistosomiasis block-like formations of variable size, separated by groove-like depressions, made the liver surface appear like a tortoise shell. In moderate or severe schistosomiasis ultrasonography revealed spotted high echoes and CT scans demonstrated network patterns and lineal calcified spots. The liver surface of chronic schistosomiasis japonica without re-infection appeared stable without change over time but with a tendency to improve. Hepatocellular carcinoma was initially recorded in two of the nine patients and follow-up revealed a further two with the same diagnosis. However, all these four cases also had chronic hepatitis C (HCV). Hepatocellular carcinoma was not detected in patients without viral hepatitis, indicating that hepatic viral infection is more important than schistosomiasis in promoting the development of hepatocellular carcinoma.