This study includes an evaluation of pathological findings on 232 complete necropsies performed on subjects with advanced hepatic schistosomiasis in Salvador, Bahia, Brazil. The constant and characteristic feature was peri-portal hepatic fibrosis with destructive and obstructive vascular lesions of the intrahepatic branches of the portal vein. Usually the lesions were accomapained by signs of portal hypertension (splenomegaly and esophageal varices) representing hepatosplenic schistosomiasis, but in 12 cases such signs were absent (advanced hepatic schistosomiasis). Some individuals progressed from a compensated to a decompensated form of hepatic schistosomiasis by showing progressive evidences of hepatic cell failure. In such cases the liver usually presented more intense septal fibrosis and changes of chronic active hepatitis, but not a transformation toward a diffuse cirrhosis. Spelonomegaly resulted from chronic passive congestion and cellular proliferation, specially of the phagocytic mononuclear system. Occasionally the enlarged spleen developed a peculiar nodular type of lymphoma. Intestinal involvement was less than expected. Only rarely some more prominent changes, such as peri-colonic and retroperitoneal fibrosis due to massive deposition of eggs, pseudo-neoplastic formations and polyps appeard. A frequent complication was cor pulmonale due to schistosomal pulmonary arteritis, which appeard in 44 cases (18,9%). Associated renal disease was found in 15% of the cases, usually represented by chronic diffuse glomerulonephritis, wich is presumed to represent a immune-complex manifestation of schistosomiasis. Concommitant infections were frequently observed, and some of them, such as salmonellosis and viral hepatitits, tended to run a rather prolonged course. Thus, advanced schistosomiasis appeard as a pathological process that damages mainly the liver, but that reaches various organs through a varied and complex pathogenesis, the mechanisms of which are...