Treatment of Budd-Chiari Syndrome by Mesocavoatrial Bypass: A case report

The Budd-Chiari syndrome or hepatic venous outflow obstruction is a rare disorder resulting from the occlusion of the major hepatic veins or the suprahepatic inferior vena cava. Several surgical procedures lay claim to superior results but in this rare disease, the proper form of hepatic venous decompression may have to be individualized. Budd-Chiari syndrome caused by occlusion of IVC above the entrance of the major hepatic veins in 26 year-old-male patient is presented. Side to side mesocaval shunt using ringed PTFE graft (1.6cm x 10cm) and interposition graft between right atrium to mesocaval graft were performed (1.6 cm x 25 cm). Combined meso-cavo-atrial bypass that decompress both the portal system and IVC has been effective in relieving Budd-Chiari syndrome caused by occlusion of IVC at diaphragm.

Treatment of Budd-Chiari Syndrome by Portacaval & Cavo-Atrial Bypass

The Budd-Chiari syndrome is no longer a rare disease in the world, but there has been small cases reported until now in Korea. There are three forms of Budd-Chiari syndrome, among them membranous web in the inferior vena cava is the most common form in the oriental area. Authors have expereinced the Budd-Chiari syndrome, 49 year old female patient, caused by membranous web associated with the long thrombus in the inferior vena cava. She underwent side-to-side portacaval shunt and cavoatrial shunt using 19 mm diameter, 25 cm length polytetrafluoroetylene graft. Postoperative major morbidities were ARF and pneumonia. She has improved clinically and pathologically after operation. It is concluded that combined portacaval shunt and cavoatrial shunt has been effective to relieve the symptoms of Budd-Chiari syndrome caused by membranous web and inferior vena cava thrombotic occlusion.