Introduction: The association of Budd-Chiari syndrome (BCS), Crohn’s disease (CD) and pregnancy is extremely rare. The successful medical treatment of BCS in the postpartum period in a woman with CD is presented.
Case report: A 28-year-old woman with CD presented with fever of 42°C and gross abdominal distention 2 days following delivery. On sonographic examination, massive ascites and hepatosplenomegaly were noted. Color Doppler ultrasonography and contrast-enhanced computed tomography revealed a thrombus in the suprahepatic inferior vena cava causing significant luminal obstruction. She was diagnosed with BCS. Medical treatment with spironolactone, furosemide, imipenem, metronidazole, and enoxaparin improved the clinical picture.
Conclusion: In a pregnant woman with CD, extreme thromboembolic events such as BCS might occur. If diagnosed early and treated in the acute phase, prognosis is fair.
Almer S, Bodemar G, Rydén BO, Elfström J, Franzén L, Ihse I, et al. Oral contraceptives and blood diseases are the most common causes of Budd-Chiari syndrome. Lakartidningen. 1989;86:4002–8.
Brinar M, Hrstic I, Cukovic-Cavka S, Padovan RS, Zupancic-Salek S, Vucelic B. Chronic Budd-Chiari syndrome as a rare complication of Crohn’s disease: a case report. Eur J Gastroenterol Hepatol. 2010;22:761–4.
Hiroe S, Itoh H, Matsumoto H, Takahasi S, Sato Y, Yamada S, et al. Case of Budd-Chiari syndrome 3 months after vaginal delivery. J Obstet Gynaecol Res. 2008;34:605–8.
Hsu HW, Belfort MA, Vernino S, Moake JL, Moise KJ Jr. Postpartum thrombotic thrombocytopenic purpura complicated by Budd-Chiari syndrome. Obstet Gynecol. 1995;85:839–43.
Ilan Y, Oren R, Shouval D. Postpartum Budd-Chiari syndrome with prolonged hypercoagulability state. Am J Obstet Gynecol. 1990;162:1164–5.
Khuroo MS, Datta DV. Budd-Chiari syndrome following pregnancy. Report of 16 cases, with roentgenologic, hemodynamic and histologic studies of the hepatic outflow tract. Am J Med. 1980; 68:113–21.
Lupescu IG, Dobromir C, Popa GA, Gheorghe L, Georgescu SA. Spiral computed tomography and magnetic resonance angiography evaluation in Budd-Chiari syndrome. J Gastrointestin Liver Dis. 2008;17:223–6.
Maccini DM, Berg JC, Bell GA. Budd-Chiari syndrome and Crohn’s disease. An unreported association. Dig Dis Sci. 1989;34:1933–6.
Millikan WJ Jr, Henderson JM, Sewell CW, Guyton RA, Potts JR 3rd, Cranford CA Jr, et al. Approach to the spectrum of Budd-Chiari syndrome: which patients require portal decompression? Am J Surg. 1985; 149:167–76.
Orloff MJ, Daily PO, Orloff SL, Girard B, Orloff MS. A 27-year experience with surgical treatment of Budd-Chiari syndrome. Ann Surg. 2000;232:340–52.
Rogers RG, Katz VL. Course of Crohn’s disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol. 1995;12:262–4.
Rosenthal T, Shani M, Deutsch V, Samra H. The Budd- Chiari syndrome after pregnancy. Report of two cases and a review of the literature. Am J Obstet Gynecol. 1972;113:789–92.
Segal S, Shenhav S, Segal O, Zohav E, Gemer O. Budd-Chiari syndrome complicating severe preeclampsia in a parturient with primary antiphospholipid syndrome. Eur J Obstet Gynecol Reprod Biol. 1996;68:227–9.
Talbot RW, Heppell J, Dozois RR, Beart RW Jr. Vascular complications of inflammatory bowel disease. Mayo Clin Proc. 1986;61:140–5.
©2013 by Walter de Gruyter Berlin Boston.
