Massive ascites secondary to ovarian schistosomiasis

Abstract

Gynaecological schistosomiasis is of major public health importance and the associated clinical diagnostic difficulty has been emphasized [1]. A case of ovarian schistosomiasis that presented with features of ovarian carcinoma was treated in our department and is here reported.

A 28‐year‐old nulligravida presented with scanty periods, anorexia, weight loss and abdominal pain and distension. She looked ill and emaciated. The abdomen was grossly distended, tender and contained free fluid. Abdominal‐pelvic ultrasonography confirmed ascites and uterine fibroids. Laparotomy revealed multiple dark red‐brown patches on the ovaries and utero‐vesical peritoneum, a left tubo‐ovarian mass, a nodular omental lesion and multiple uterine fibroids. Nine liters of ascitic fluid was drained, the tubo‐ovarian mass and omental lesion were removed and myomectomy performed.

Histology of the ovary showed granulomatous (Bilharzial) oophoritis with pseudotubercle formation around Schistosoma mansoni ova. The lymph node showed nonspecific reactive sinus hyperplasia and there were focal glandular elements suggestive of endometriosis and fatty necrosis in the omentum. Ascitic fluid cytology was negative and histology of the fibroids showed leiomyomata.

Complete cure was achieved after five 4‐weekly courses of praziquantel, (Cysticide®, Merck) 1600 mg in two divided doses 6 h apart and 6 months of treatment with danazol (danol®, Sanofi Winthrop).

Schistosomiasis affects the urinary tract, colon and rectum, and not infrequently the genital organs when schistosoma ova are transported through the blood stream or migration of the adult worm through the haemorrhoidal and hypogastric venous anastomosis occurs. Rarely the adult worm reaches the genital organs through communication between the ovarian and inferior mesenteric veins