[An iliac-mesenteric-atrial shunt in the Budd-Chiari syndrome with extensive thrombosis of the inferior vena cava].

A 34-year-old woman with no history of any liver diseases was admitted to the service for a Budd-Chiari syndrome and an extensive thrombosis of the inferior vena cava. The symptoms of the portal hypertension were present, with an enormous ascites, mild esophagogastric varices, associated with increased edema of the lower limbs, perineum and abdominal wall. The diagnosis was established by color Doppler ultrasonography, CT and cavography. An ilio-mesenterico-atrial shunt, between the right iliac vein, the superior mesenteric vein and the right atrium was successfully performed, transdiaphragmatically, by abdominally and right thoracic approach, using a 35 cm Dacron prosthesis. Postoperative evolution was very good. The color Doppler ultrasonography showed a good flow in the shunts. After 14 days ascites decreased over 70% and the inferior edema almost disappeared. 2 month later ascites decreased over 80%, the esophageal varices and edema disappeared completely. To our knowledge, this is the first case in the country, in which a patient underwent ilio-mesenterico-atrial shunt for Budd-Chiari syndrome and inferior vena cava extensive thrombosis.