Wound management with compression therapy and topical hemoglobin solution in a patient with Budd-Chiari Syndrome

Wir berichten über einen Patienten mit Budd-Chiari Syndrom welcher unter intravenöser Antikoagulation eine Heparin induzierte Thrombozytopenie entwickelte. Die chirurgische Behandlung bestand aus einer dorsocranialen Leberresektion mit anschliessender hepato-atrialer Anastomose unter Verwendung der extrakorporellen Zirkulation. Die perioperative Antikoagulation wurde mittels Hirudin durchgeführt. Erstaunlicherweise wurde während der Operation eine Thrombusbildung im Kardiotomie-Reservoir der Herz-Lungenmaschine beobachtet, obwohl die intraoperativ gemessene Antikoagulationsparameter (ACT und aPTT) im therapeutischen Bereich waren. Mit einem zusätzlichen Bolus Hirudin in das extrakorporelles Circuit und dank Spülung des Reservoirs konnte die Operation ohne weitere thrombotische Ereignisse zu Ende geführt werden.

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Budd-Chiari syndrome due to segmental obstruction of the inferior vena cava successfully managed with endovascular stenting

MedPharmRes ◽

10.32895/ump.mpr.2.3.22 ◽

2018 ◽

Vol 2 (3) ◽

pp. 22-26

Author(s):

Uyen Vo ◽

Duc Quach ◽

Luan Dang ◽

Thao Luu ◽

Luan Nguyen

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Laboratory Data ◽

Transaminase Level ◽

Vena Cava ◽

Budd Chiari Syndrome ◽

Endovascular Stenting ◽

Massive Ascites ◽

Chiari Syndrome ◽

History Of

Budd–Chiari syndrome (BCS), a rare and life-threatening disorder due to hepatic venous outflow obstruction, is occasionally associated with hypoproteinemia. We herein report the first case of BCS with segmental obstruction of the intrahepatic portion of inferior vena cava (IVC) and hepatic veins (HVs) successfully treated by endovascular stenting in Vietnam. A 32-year-old female patient presented with a 2-month history of massive ascites and leg swelling. She refused history of oral contraceptives use. Hepatosplenomegaly without tenderness was noted. Laboratory data showed polycythemia, mild hypoalbuminemia and hypoproteinemia, slightly high total bilirubin and normal transaminase level. The serum ascites albumin gradient was 1.9 g/dL and ascitic protein level was 1.1 g/dL. The other data were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. On abdominal magnetic resonance imaging, the segmental obstruction of three HVs and IVC was 2-3 cm long without thrombus. Cavogram revealed the severe segmental stenosis of intrahepatic portion of IVC with no visualized HV and extensive collateral veins. A Protégé stent was deployed to IVC. Leg swelling and ascites were completely resolved within 3 days after stenting. During 1-year follow-up, edema was not recurred and repeated laboratory results were all normal.

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Case report of Budd-Chiari syndrome

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1985.21.3.473 ◽

1985 ◽

Vol 21 (3) ◽

pp. 473

Author(s):

J H Lee ◽

E K Kim ◽

Y T Ko ◽

Y Yoon ◽

S W Lee ◽

...

Keyword(s):

Case Report ◽

Budd Chiari Syndrome ◽

Chiari Syndrome

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Diagnosis of Budd-Chiari Syndrome by Measuring the Diameter of Azygos-hemiazygos Vein on CT

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1995.32.5.763 ◽

1995 ◽

Vol 32 (5) ◽

pp. 763

Author(s):

Moon Gyu Lee ◽

Yong Ho Auh ◽

Cheol Min Park ◽

Gi Young Ko ◽

Sang Hee Choi

Keyword(s):

Budd Chiari Syndrome ◽

Hemiazygos Vein ◽

Chiari Syndrome

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Splanchnic vein closures

Perspectives in Surgery ◽

10.33699/pis.2019.98.6.239-244 ◽

2019 ◽

Vol 98 (6) ◽

pp. 239-244

Keyword(s):

Portal Vein ◽

Surgical Approach ◽

Medical Problem ◽

Budd Chiari Syndrome ◽

Extrahepatic Portal Vein Obstruction ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Portal Vein Obstruction ◽

Chiari Syndrome ◽

Outflow System

Closures in the splanchnic venous system (SVS) represent a broad medical problem. Anatomically, individual or even multiple sections of SVS may be affected at the same time. Main sections of SVS include the venous liver outflow system, the portal vein, and the upper mesenteric vein and its basin. Thrombosis is clearly the predominant cause of closure. The closures can present as acute, subacute, chronic occult or chronic manifest. The main pathological and anatomical units are the Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO) and mesenteric vein thrombosis (MVT). Advanced laboratory, imaging and intervention methods substantially modify the approach to prevention, diagnosis and treatment; surgical approach also plays a role. The problem of SVS closures is interdisciplinary.

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