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Is surgical portosystemic shunt the treatment of choice in Budd-Chiari Syndrome ?

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Introduction Budd-Chiari syndrome (BCS) consists of hepatic venous outflow obstruction and its manifestations, regardless of the cause and regardless of the level of obstruction from the small hepatic veins to the entrance of the right atrium (1). Outflow obstruction caused by hepatic veno-occlusive disease and cardiac disorders are excluded. Although the cause, the mechanism and the nature of the obstacle are not given, the term Budd- Chiari Syndrome should be retained according to the European Group for the Study of Budd-Chiari Syndrome (The Prague nomenclature for BCS) (1). Clinical presentation is variable depending on the degree and the speed of venous obstructions (2). Its presenting symptoms vary widely from mild ascites with slightly elevated liver function easily controlled by diuretics and anticoagulants, to acute liver failure requiring liver transplantation. BCS is considered asymptomatic when there is neither abdominal pain, ascites nor hepatomegaly, jaundice, leg oedema, encephalopathy or gastro-intestinal bleeding nor any history of them. Based partly on our personal experience (3), manifestations and duration of BCS should permit to classify... [Product Details...]