Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2862-2864
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2862
Perforation of small bowel caused by Schistosoma japonicum: A case report
Jin-Jian Xiang, Ben-Jing Cheng, Fu Tian, Mi Li, Xue-Feng Jiang, Hui-Chuan Zhao, Xiao-Miao Hu, Bao-Lai Xiao, Jian-Ping Xie, Arpana Shrestha
Jin-Jian Xiang, Ben-Jing Cheng, Fu Tian, Mi Li, Xue-Feng Jiang, Xiao-Miao Hu, Bao-Lai Xiao, Jian-Ping Xie, Arpana Shrestha, Department of General Surgery, the First Hospital affiliated to Yangtze University, Jingzhou 434000, Hubei Province, China
Hui-Chuan Zhao, Department of Pathology, the First Hospital Affiliated to Yangtze University, Jingzhou 434000, Hubei Province, China
Author contributions: Xiang JJ and Cheng BJ designed the report; Xiang JJ, Tian F, Li M and Jiang XF performed surgical operation; Hu XM, Xiao BL and Xie JP were attending doctors for the patient; Cheng BJ wrote paper; Zhao HC performed pathological examinations and imaging diagnosis; and Shrestha A polished the article.
Ethics approval: The study was reviewed and approved by the First Hospital affiliated to Yangtze University Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ben-Jing Cheng, Nurse-in-Charge, Department of General Surgery, the First Hospital affiliated to Yangtze University, No. 8, Hangkong Road, Shashi District, Jingzhou 434000, Hubei Province, China. 309802903@qq.com
Telephone: +86-716-8115071 Fax: +86-716-8118888
Received: September 22, 2014
Peer-review started: September 23, 2014
First decision: October 29, 2014
Revised: November 26, 2014
Accepted: December 13, 2014
Article in press: December 16, 2014
Published online: March 7, 2015
Abstract

A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz’s ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum.

Keywords: Schistosoma japonicum, Intestinal perforation, Small bowel

Core tip: There are rare cases of intestinal perforation caused by schistosomiasis. When patients living in an endemic area for schistosomiasis develop intestinal perforation, the condition may be caused by Schistosoma. We present a case report of a patient from Jingzhou, China with small bowel perforation with peritonitis secondary to infection with S. japonicum.