Gao Bin, Zhang Jingjing, Zhu Lei, Zhang Yaming
Department of General Surgery, Anqing Municipal Hospital, Anqing, China.
Front Med (Lausanne). 2025 May 9;12:1544400. doi: 10.3389/fmed.2025.1544400. eCollection 2025.
Hepatic sinusoidal obstruction syndrome (HSOS) is often caused by the ingestion of pyrrolizidine alkaloids (PAs). To date, research on PAs-induced HSOS remains limited. Due to differing etiologies of HSOS in Western and Eastern populations, the clinical features, imaging findings, treatment approaches, and outcomes of HSOS caused by hematopoietic stem cell transplantation or oxaliplatin may not be directly applicable to PAs-induced HSOS. PAs-induced HSOS commonly presents with painful hepatomegaly, ascites, and jaundice. Laboratory tests commonly show abnormal liver function in patients with PA-induced HSOS. Contrast-enhanced computed tomography and magnetic resonance imaging often reveal distinctive imaging features and significant histopathological liver changes in PAs-induced HSOS. These findings highlight the effectiveness of radiological imaging and liver biopsy as diagnostic tools. Treatment strategies for PAs-induced HSOS include fluid management, anticoagulation therapy, glucocorticoids, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, managing PAs-induced HSOS remains challenging. This paper presents the case of an elderly male diagnosed with gastric cancer complicated by hepatic sinusoidal obstruction syndrome. The diagnosis was based on characteristic imaging findings, a history of pyrrolizidine alkaloids ingestion, and standard diagnostic criteria, including liver biopsy and histological examination. The patient recovered fully after timely diagnosis and treatment, which included radical total gastrectomy, hepatoprotective diuretics, albumin supplementation, and low-molecular-weight heparin therapy.
肝窦阻塞综合征（HSOS）常由摄入吡咯里西啶生物碱（PAs）引起。迄今为止，关于PAs诱导HSOS的研究仍然有限。由于西方和东方人群中HSOS的病因不同，造血干细胞移植或奥沙利铂所致HSOS的临床特征、影像学表现、治疗方法及预后可能不适用于PAs诱导的HSOS。PAs诱导的HSOS通常表现为肝肿大伴疼痛、腹水和黄疸。实验室检查通常显示PAs诱导的HSOS患者肝功能异常。对比增强计算机断层扫描和磁共振成像常显示PAs诱导的HSOS具有独特的影像学特征和明显的肝脏组织病理学变化。这些发现突出了放射影像学和肝活检作为诊断工具的有效性。PAs诱导的HSOS的治疗策略包括液体管理、抗凝治疗、糖皮质激素、经颈静脉肝内门体分流术（TIPS）和肝移植。然而，管理PAs诱导的HSOS仍然具有挑战性。本文介绍了一例老年男性患者，诊断为胃癌合并肝窦阻塞综合征。诊断基于特征性影像学表现、吡咯里西啶生物碱摄入史以及包括肝活检和组织学检查在内的标准诊断标准。患者经及时诊断和治疗后完全康复，治疗包括根治性全胃切除术、保肝利尿剂、补充白蛋白和低分子量肝素治疗。
