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Budd-Chiari syndrome and extensive inferior vena cava thrombosis treated with sequential interventional radiology and transjugular intrahepatic portosystemic shunting: A case report from Kenya
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 c...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10031605/ https://www.ncbi.nlm.nih.gov/pubmed/36968991 http://dx.doi.org/10.1177/2050313X231161190 |
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author | Kuka, Werimo Pascal Nduati, Paul Kareithi Mwirigi, Anne Opio, Christopher K |
author_facet | Kuka, Werimo Pascal Nduati, Paul Kareithi Mwirigi, Anne Opio, Christopher K |
author_sort | Kuka, Werimo Pascal |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10031605 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-100316052023-03-23 Budd-Chiari syndrome and extensive inferior vena cava thrombosis treated with sequential interventional radiology and transjugular intrahepatic portosystemic shunting: A case report from Kenya Kuka, Werimo Pascal Nduati, Paul Kareithi Mwirigi, Anne Opio, Christopher K SAGE Open Med Case Rep Case Report 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. SAGE Publications 2023-03-21 /pmc/articles/PMC10031605/ /pubmed/36968991 http://dx.doi.org/10.1177/2050313X231161190 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Case Report Kuka, Werimo Pascal Nduati, Paul Kareithi Mwirigi, Anne Opio, Christopher K Budd-Chiari syndrome and extensive inferior vena cava thrombosis treated with sequential interventional radiology and transjugular intrahepatic portosystemic shunting: A case report from Kenya |
title | Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya |
title_full | Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya |
title_fullStr | Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya |
title_full_unstemmed | Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya |
title_short | Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya |
title_sort | budd-chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: a case report from kenya |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10031605/ https://www.ncbi.nlm.nih.gov/pubmed/36968991 http://dx.doi.org/10.1177/2050313X231161190 |
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