[Portal hypertension and schistosomiasis: "an originally killing entity"]

In some regions of Africa, Middle-east and Asia, portal hypertension is caused most frequently by bilharziasis far more than by post-hepatic or alcoholic cirrhosis. All schistosomiasis induce hepatic affection, consequence of the eggs embolization in the vessels endings of the portal system, but only Schistosoma mansoni and Asian bilharziasis mainly the Schistosoma japonicum are the cause of severe sequelar fibrosis responsible for a particular portal hypertension. This portal hypertension is original anatomopathologically and physiopathologically. The perivascular concentric fibrosis localised in the portal space is an anatomopathological sequela of bilharzious granulomas outlining embolized eggs. This "stem pipe" aspect constitutes a presinusoidal block inducing a severe portal hypertension without hepatic lobule affection. The recent medical advances regarding this pathology lie in the understanding of the responsible immune mechanisms, the diagnosis and follow-up thanks to ecographic codification of lesions, the complications treatment through varix endoscopic ligature or portal vein derivation. Treatment by praziquantel remains justified together with health education, improving living standard and hopes placed in the future vaccination campaigns associated with medical treatment in endemic areas.