Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2018; 10(9): 107-110
Published online Dec 27, 2018. doi: 10.4240/wjgs.v10.i9.107
Pancreaticoduodenectomy complicated by Budd-Chiari syndrome: A case report and review of literature
Damien Dousse, Eric Bloom, Bertrand Suc
Damien Dousse, Eric Bloom, Department of Visceral Surgery, Toulouse-Purpan University Hospital, 31059 Toulouse Cedex 9, France
Damien Dousse, Bertrand Suc, Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
Author contributions: Dousse D and Bloom E performed research and wrote the manuscript; Suc B provided critical revision of the manuscript for important intellectual content.
Informed consent statement: The patient was not required to give informed consent to the study because the analysis used anonymized clinical data that were obtained after the patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bertrand Suc, MD, Professor, Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 1 Avenue du Pr Jean Poulhès, 31059 Toulouse Cedex 9, France. suc.b@chu-toulouse.fr
Telephone: +33-56-1322937 Fax: +33-56-1322936
Received: June 28, 2018
Peer-review started: June 30, 2018
First decision: July 19, 2018
Revised: November 4, 2018
Accepted: November 8, 2018
Article in press: November 8, 2018
Published online: December 27, 2018
Processing time: 181 Days and 14.9 Hours
Abstract
BACKGROUND

Pancreaticoduodenectomy (PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some life-threatening complications remain atypical and undescribed.

CASE SUMMARY

We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings (i.e., acute liver failure) and radiological findings (i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature.

CONCLUSION

Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.

Keywords: Pancreaticoduodenectomy; Pancreatic fistula; Acute liver failure; Budd-Chiari syndrome; Case report

Core tip: Pancreaticoduodenectomy (PD) is responsible for significant morbidity and mortality. Pancreatic fistula (PF), the main complication of this surgery, has been the subject of many clinical practice guidelines releases to recommend its definition, prevention, and management. However, some clinical presentations of severe PF after PD remain atypical and undescribed. We report here a case of acute Budd-Chiari syndrome in relation to a compressive hematoma of the retrohepatic vena cava due to massive postpancreatectomy hemorrhage. Emergency relaparotomy to remove the compressive hematoma enabled rapid improvement. Awareness of this potential life-threatening complication may help avoid a delay in diagnosis and to propose an appropriate therapeutic strategy.