Surgery for Pulmonary Parenchymatous Schistosomiasis (Bilharziomas): A 20-Year Single-Centre Experience

Pulmonary schistosomiasis may complicate urinary or intestinal infestations. Pulmonary pathology is either in the acute or chronic form. The chronic form of the disease may result in granuloma formation. This study presents 20 years of experience in surgical management of pulmonary bilharziomas.

A retrospective review was undertaken of 17 consecutive patients who had surgery for lung bilharziomas from 1996-2016. Demographics, clinical presentation, underlying lung disease, investigations performed, operative procedure, and outcome were retrieved and reviewed.

All patients were males, with ages ranging from 22-52 years (median 33 years). Haemoptysis was the main presentation (53%). Coexisting lung tuberculosis was present in five (29.4%) patients. Indications for surgery were solitary shadows in 12 (70.6%) patients and persistent tuberculous cavities in five (29.4%) patients. Segmentectomy was performed in one (5.9%) patient, lingulectomy in one (5.9%) patient, lobectomy in 14 (82.3%) patients, and bi-lobectomy in one (5.9%) patient. The histologic nature of the infestation was: bilharzial ova with extensive granulomatous reaction and suppuration in eight cases (47%); both tuberculosis and bilharzial ova within a granulomatous tissue reaction in five cases (29.4%); and bilharzial ova within malignant tissue in four cases (23.6%). There was no operative mortality. One (1) patient (5.9%) developed postoperative bronchopleural fistula after left upper lobectomy; surgical repair of the fistula and omental flap buttress was needed after failure of conservative management.

Pulmonary schistosomiasis is not an uncommon infestation and occurs more frequently in patients with underlying tuberculosis. It may predispose to granulomatous parenchymatous lung masses or even malignancy, which necessitate surgical intervention with a good outcome. However, predisposition of pulmonary schistosomiasis for the development of bronchogenic carcinoma warrants further studies.