Kuka WP, Nduati PK, Mwirigi A, Opio CK. Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya.
SAGE Open Med Case Rep 2023;
11:2050313X231161190. [PMID:
36968991 PMCID:
PMC10031605 DOI:
10.1177/2050313x231161190]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/14/2023] [Indexed: 03/24/2023] Open
Abstract
Budd-Chiari syndrome is a rare disease characterized by the obstruction of
hepatic venous outflow. Stepwise treatment options aimed to relieve obstruction
and prevent complications of Budd-Chiari syndrome are medical therapy,
interventional recanalization, and surgery. Aggressive interventions for
complicated Budd-Chiari syndrome are placement of a transjugular intrahepatic
portosystemic shunt, surgical shunting, or liver transplantation. Although
literature suggests differences in the presentation and management between
Europe and Asia, cases documenting successful use of stepwise management of
Budd-Chiari syndrome in Sub-Saharan Africa are scarce. A 47-year-old male on
treatment for chronic hepatitis B presented with abdominal pain and distension
for 2 weeks and findings of gross ascites without stigmata of chronic liver
disease. Laboratory investigations performed showed anemia, elevated
transaminases, coagulopathy, and renal dysfunction. Abdominal ultrasound and
computed tomography abdominal scan revealed filling defects in intrahepatic
veins and inferior vena cava extending to bilateral renal and external iliac
veins. Extensive workup for thrombophilia and myeloproliferative disorders was
negative. The diagnosis was hepatic dysfunction secondary to inferior vena cava
obstruction due to a thrombus in the setting of extensive inferior vena cava
thrombosis, and heparin was initiated. However, due to lack of recanalization
with anticoagulation, we performed aspiration thrombectomy, balloon angioplasty,
and local thrombolysis. Transjugular intrahepatic portosystemic shunt procedure
was subsequently done due to hepatic venous congestion and refractory ascites.
He was discharged on oral anticoagulation. Imaging exams performed 4 months
later showed patent inferior vena cava and transjugular intrahepatic
portosystemic shunt, good flows in the portal vein and resolution of
ascites.
Collapse