Introduction: Bilharzia or hepato-splenic schistosomiasis is caused by lesions related to Schistosoma mansoni, a trematode of the genus Schistosoma. This chronic waterborne parasitic disease is a major public health problem in sub-Saharan Africa, where it is endemic. It can be complicated by gastrointestinal bleeding due to rupture of esophageal varices.The aim of this observation is to report on the diagnostic approach and challenges of advanced-stage hepatosplenic bilharzia in a resource-limited setting.

Case History: we report the case of a 20-year-old man with a history of swimming in fresh water, hematemesis due to rupture of varices, lost to follow up and admitted to our department for hematemesis, and in whom clinical and paraclinical examination led to a diagnosis of chronic hepatosplenic bilharzia complicated by gastrointestinal bleeding due to rupture of esophageal varices. The patient was treated for his gastrointestinal bleeding and administered anti-bilharzia treatment. The outcome was straightforward.

Conclusion: Hepatosplenic bilharzia remains a major public health problem in Burkina Faso. In countries with limited resources, and particularly in a medium-sized town such as Ouahigouya, diagnosis is often based on a combination of epidemiological, clinical, and, above all, radiological evidence.