Emergency rescue hepatic transplantation following shunt surgery for Budd-Chiari syndrome

Objective: Assessment and optimal surgical treatment of a patient with Budd-Chiari syndrome. Design: A single patient case report with a brief review of the literature regarding choice of surgical treatment: shunt surgery versus orthotopic liver transplantation. Setting: Departments of medicine and surgery in two university hospitals. Patient: A 20-year-old woman presented with a 4-week history of ascites. The patient was diagnosed as having Budd-Chiari syndrome. There was no hepatic fibrosis on histology and synthetic function was well preserved. She fulfilled the published criteria for shunt surgery. Despite anticoagulation treatment over 4 weeks, she experienced mild deterioration. Shunt surgery resulted in fulminant hepatic failure requiring liver transplantation. Interventions: Porto-caval shunt surgery with subsequent emergency orthotopic liver transplantation. Outcome: The patient died. Conclusions: Clinical deterioration, even if apparently mild, may indicate a need to re-evaluate the choice of surgery. Surgical treatment should occur in centres where liver transplantation is available. © 1994 Current Science Ltd.