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The Budd-Chiari syndrome and hepatic veno-occlusive disease. Recognition and treatment

W V McDermott1, P M Ridker

  • 1Department of Surgery, New England Deaconess Hospital, Boston, Mass 02215.

Archives of Surgery (Chicago, Ill. : 1960)
|April 1, 1990
PubMed

Insights

This study highlights pyrrolizidine alkaloids as a cause of Budd-Chiari syndrome. Surgical decompression proved effective for patients with toxic-induced liver injury.

Area of Science:

  • Hepatology
  • Toxicology
  • Gastroenterology

Background:

  • Budd-Chiari syndrome, characterized by hepatic venous outflow obstruction, can arise from diverse etiologies.
  • Intractable ascites necessitates advanced treatment strategies, including surgical interventions.

Observation:

  • A review of 29 patients undergoing hepatic and portal decompression identified 18 with Budd-Chiari syndrome.
  • Two specific cases presented with classical hepatic venous endophlebitis, linked to pyrrolizidine alkaloid exposure.

Findings:

  • One patient exposed to "bush teas" and another consuming comfrey tea (high in pyrrolizidine alkaloids) developed Budd-Chiari syndrome.
  • The findings support the etiological role of pyrrolizidine alkaloids in hepatic venous endophlebitis.

Implications:

  • Pyrrolizidine alkaloid toxicity is a significant, yet often overlooked, cause of Budd-Chiari syndrome.
  • Combined hepatic and portal decompression is an effective treatment for this specific type of liver injury.

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