Gologan E, Achiţei D, Bălan G
Universitatea de Medicină si Farmacie "Gr. T. Popa", Iaşi, România.
Chirurgia (Bucur). 2011 May-Jun;106(3):395-400.
The Budd-Chiari syndrome represents the obstruction of hepatic veins usually due to a hepatocarcinoma. We present the case of a 68 year old patient, in medical evidence for ten years with a Child A ethanolic liver cirrhosis, who was admitted in emergency for hematemesis and melena. Clinical examination and the laboratory findings at the admittance revealed signs of decompensated cirrhosis and severe anemia. Ultrasound examination showed a cirrhotic liver with portal hypertension signs and a multinodular mass in the right lobe of the liver with portal, biliary and right hepatic vein invasions extended to inferior caval vein. In upper digestive endoscopy stage IV esophageal varices were evidenced with signs of recent bleeding (sclerotherapy was performed) along with gastric varices and portal gastropathy. The particularity of the case consists in the invasive complications of the hepatocarcinoma regarding hepatic and inferior caval veins wich defines the Budd-Chiari syndrome (posthepatic portal hypertension added to the intrahepatic and prehepatic ones), the invasions of the biliary tract and portal vein being more frequent.
布加综合征通常是由于肝癌导致肝静脉阻塞。我们报告一例68岁患者，有10年酒精性肝硬化Child A级病史，因呕血和黑便急诊入院。入院时的临床检查和实验室检查结果显示有失代偿期肝硬化和严重贫血的体征。超声检查显示肝脏呈肝硬化表现，有门静脉高压体征，右肝叶有一个多结节肿块，侵犯门静脉、胆管和右肝静脉，并延伸至下腔静脉。上消化道内镜检查发现IV期食管静脉曲张并有近期出血迹象（已进行硬化治疗），同时还有胃静脉曲张和门静脉性胃病。该病例的特殊性在于肝癌侵犯肝静脉和下腔静脉导致布加综合征（肝后性门静脉高压叠加肝内和肝前性门静脉高压），胆道和门静脉受侵犯更为常见。
