Abstract
Abstract Budd–Chiari syndrome is a rare disease and is a significant cause of cirrhosis. We report a clinical case of a 23-year-old patient, highlighting the diagnostic and therapeutic difficulties of Budd–Chiari syndrome at the cirrhosis stage in a country with limited resources such as Togo. A 23-year-old, nonalcoholic, patient who tested negative for hepatitis B and C virus presented with progressive abdominal distension. Examination revealed grade 2 ascites and soft, painless, cold, bucketing edema of the lower limbs rising to the knees. The calculated serum-ascites albumin gradient was 12 g/L. Abdominal ultrasound and abdominal computed tomography indicated the presence of thrombosis of the inferior vena cava, which ascended to the hepatic veins. Biological signs of hepatocellular insufficiency such as a low prothrombin time (56%) and low serum albumin levels (22 g/L) with a beta-gamma block were also found. Upper gastrointestinal endoscopy revealed grade 3 esophageal varices with red signs. The diagnosis of Budd–Chiari syndrome at the stage of cirrhosis classified as Child–Pugh score 9 decompensated in the ascitic mode, complicated by grade 3 esophageal varices with red signs, was retained. Due to the inadequacy of the technical facilities in Togo, and also because of financial difficulties, aetiological work-up was not carried out. Anticoagulant treatment with rivaroxaban 10 mg/day has been instituted. The clinical outcomes were poor with gastrointestinal bleeding, stage 3 hepatic encephalopathy, and death on the 46th day. The prognosis of Budd–Chiari syndrome is poor in resource-limited countries such as Togo. It depends on the quality of care, not only of the etiology but also of the complications of cirrhosis.
Published Version
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