Maham Tariq, MBBS1, Haseeb Ali, MD2, Ahmad Zain, MBBS3, Muhammad Omar Akram, MD4 1Services Hospital Lahore, Lahore, Punjab, Pakistan; 2Services Hospital Lahore, Albany, NY; 3Parkview Medical Center, Pueblo, CO; 4AdventHealth, Orlando, FL Introduction: Ulcerative colitis (UC) is a well-known hypercoagulable condition with a threefold increased risk of deep venous thrombosis (DVT) and pulmonary embolism. However, thrombosis of systemic veins is rare. Herein, we present a case of Budd-Chiari syndrome (BCS) treated with transjugular intrahepatic portosystemic shunt (TIPS) in a patient with UC.
Case Description/
Methods: A 24-year-old woman with a past medical history of UC presented to the emergency department with abdominal pain, vomiting, and bloody diarrhea. On physical examination, she was afebrile with blood pressure 122/92 mm Hg and pulse 135 bpm; her abdomen was soft and non-distended but tender in the right upper quadrant. Laboratory evaluation revealed a hemoglobin of 6.4 g/dl, white blood cell count of 14.7cells/μL, lactic acid 6.1 mmol/L, AST 5858 U/L and ALT 3543 U/L, prothrombin time 37.3 seconds and INR 3.82. Computed tomography (CT) of abdomen and pelvis showed hepatic congestion and thrombosis of hepatic veins, portal vein and splenic vein. Sigmoidoscopy revealed pancolitis. Her infectious work-up including blood cultures, viral hepatitis panel, Clostridium difficile infection screen, stool bacterial and viral PCR, and HIV were all negative. She was started on systemic steroids, empiric antibiotics and low-molecular-weight-heparin. For definitive treatment of fulminant hepatic failure, TIPS was performed which relieved the portal hypertension. The patient’s condition stabilized and she was discharged home
Discussion: Budd-Chiari syndrome is a rare but life-threatening manifestation of UC. The underlying mechanism may include an imbalance of procoagulant and anticoagulant factors in the blood induced by the widespread inflammatory processes. Extensive colonic disease, recent surgery and inherited and acquired disorders of thrombogenesis may predispose the patient to this condition. If the patient does not respond to initial anticoagulation, more aggressive treatment in the form of TIPS may be required to relieve hepatic congestion. A high index of suspicion is required for timely diagnosis and management of this rare condition.
Figure: Computerized Tomography (CT) Scan images showing thromboses (yellow arrow) in Hepatic veins (Subsets A and B), Portal vein (Subset C) and Splenic vein (Subset D)
Figure: Transjugular Intrahepatic Portosystemic Shunt (TIPS) being performed
Disclosures: Maham Tariq indicated no relevant financial relationships. Haseeb Ali indicated no relevant financial relationships. Ahmad Zain indicated no relevant financial relationships. Muhammad Omar Akram indicated no relevant financial relationships.
Maham Tariq, MBBS1, Haseeb Ali, MD2, Ahmad Zain, MBBS3, Muhammad Omar Akram, MD4. P5963 - Budd-Chiari Syndrome in a Patient of Ulcerative Colitis Treated With Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
