Bilharzial cirrhosis of the liver

Almost 60 years ago Symmers first described the morbid anatomy and histo-pathology peculiar to bilharzial cirrhosis of the liver. He noted and emphasized the unusual and prominent periportal distribution of the fibrous tissue 'as if a number of white day-pipe stems had been thrust at various angles through the organ.' Following his experimental work with monkeys and his experience with human cirrhosis, Fairley concluded that 'pipestem cirrhosis represented the most advanced type of hepatic involvement as a result of prolonged and repeated (bilharzial) infections.' He also showed that many intermediate stages existed caused by both S. mansoni and S. haematobium. At about the same time Japanese workers reported their experience, both clinical and experimental, with S. japonicum infections and showed clearly that oriental schistosomiasis (as S. japonicum infections came to be named) produced hepatosplenic involvement indistinguishable from that of Egyptian splenomegaly. (S. japonicum, a human intestinal type, is exclusive to the East and therefore will be excluded from the present discussion. It produces lesions similar to those of S. mansoni). The morbid anatomy, histopathology and pathogenesis of bilharzial hepatic fibrosis have been under discussion since Symmers first noted the association of 'pipe-stem cirrhosis with a concomitance of bilharzial ova.' The 3 cases presented in this paper are examples of schistosomal 'pipe-stem' cirrhosis encountered at autopsy in King Edward VIII Hospital. No previous cases have been described from this area.