Case Report
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World J Hepatol. Jun 27, 2011; 3(6): 164-169
Published online Jun 27, 2011. doi: 10.4254/wjh.v3.i6.164
Budd-Chiari syndrome in a patient with ulcerative colitis and no inherited coagulopathy
Sunil Dacha, Manjari Devidi, Evan Osmundson
Sunil Dacha, Manjari Devidi, Evan Osmundson, Department of Internal Medicine, Saint Joseph Hospital, 2900 N. Lake Shore Drive, Chicago, IL 60657, United States
Author contributions: Dacha S and Osmundson E contributed equally to this work; Dacha S, Devidi M and Osmundson EC established concepts, gathered data and performed the literature review; and Dacha S and Osmundson E wrote the paper.
Correspondence to: Evan Osmundson, MD, PhD, Department of Internal Medicine, Saint Joseph Hospital, 2900 N. Lake Shore Drive, Chicago, IL 60657, United States.
Telephone: +1-773-665-3017 Fax: +1-773-665-3384
Received: December 14, 2010
Revised: May 17, 2011
Accepted: May 24, 2011
Published online: June 27, 2011

We report a case of 27 year old female patient who was admitted to the hospital with an acute flare up of ulcerative colitis. The patient presented with complaints of persistent abdominal pain and bloody diarrhea despite aggressive therapy for her ulcerative colitis. A CT scan of the abdomen on admission revealed hepatic vein thrombosis, suggesting a diagnosis of Budd-Chiari syndrome. Significantly, an associated thrombosis of the inferior mesenteric vein was also detected. Based on imaging data and clinical assessment, the patient was started on anticoagulation therapy and an extensive work-up for hypercoagulability was initiated. Up to the time of publication, no significant findings suggesting this patient has an underlying coagulation disorder have been found. Based on our search of PUBMED, this report is one of only five reported adult cases of Budd-Chiari Syndrome associated with ulcerative colitis in the English literature in living patients without evidence of a co-existing coagulation disorder. This case highlights the potential for thrombosis at unusual sites in ulcerative colitis patients even in the absence of classical coagulation abnormalities. In addition to the case presented, we provide a brief review of previously reported cases of Budd-Chiari Syndrome occurring in patients with inflammatory bowel disease.

Keywords: Ulcerative colitis, Inflammatory bowel disease, Budd-Chiari syndrome, Thrombosis, Coagulopathy