MDT discussion of a case of clonorchiasis with Budd<b>-</b>Chiari syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yin , YOU Ke , WANG Jiaguo ,  LIU Zuojin

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

LIU Zuojin, Email: 300376@hospital.cqmu.edu.cn

Keywords：

multidisciplinary team; clonorchiasis; Budd-Chiari syndrome; direct intrahepatic portosystemic shunt; percutaneous transluminal angioplasty

DOI：

10.7507/1007-9424.202206042

Video：

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Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team (MDT) discussion. Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021. We summarized the discussion of MDT and the process of diagnosis and treatment. Results The patient was admitted because of “more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”. Eight years before admission, the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver. Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction, and parasitic infection was considered. One year before admission, the patient began to have ascites, and the medical treatment was ineffective. The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava, unclear display of the hepatic veins and a large amount of ascites. After MDT discussion, this patient underwent direct intrahepatic portosystemic shunt (DIPS) and percutaneous transluminal angioplasty (PTA) , and the stent was unobstructed in the 9-month follow-up after discharge, and no recurrence of ascites was found. Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with Budd-Chiari syndrome. Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.

Citation： LI Yin, YOU Ke, WANG Jiaguo, LIU Zuojin. MDT discussion of a case of clonorchiasis with Budd-Chiari syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1174-1180. doi: 10.7507/1007-9424.202206042 Copy

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2.	Qian MB, Utzinger J, Keiser J, et al. Clonorchiasis. Lancet, 2016, 387(10020): 800-810.
3.	Na BK, Pak JH, Hong SJ. Clonorchis sinensis and clonorchiasis. Acta Trop, 2020, 203: 105309. doi: 10.1016/j.actatropica.2019.105309.
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7.	Miller WJ, Federle MP, Straub WH, et al. Budd-Chiari syndrome: imaging with pathologic correlation. Abdom Imaging, 1993, 18(4): 329-335.
8.	DeLeve LD, Valla DC, Garcia-Tsao G, et al. Vascular disorders of the liver. Hepatology, 2009, 49(5): 1729-1764.
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10.	Sharma A, Keshava SN, Eapen A, et al. An update on the management of Budd-Chiari syndrome. Dig Dis Sci, 2021, 66(6): 1780-1790.
11.	Poisson J, Plessier A, Kiladjian JJ, et al. Selective testing for calreticulin gene mutations in patients with splanchnic vein thrombosis: A prospective cohort study. J Hepatol, 2017, 67(3): 501-507.
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28.	Sun X, Qin T, Zhang J, et al. The outcomes of interventional treatment for Budd-Chiari syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis. Gastroenterol Hepatol, 2021, 44(6): 405-417.
29.	Zhang F, Wang C, Li Y. The outcomes of interventional treatment for Budd-Chiari syndrome: systematic review and meta-analysis. Abdom Imaging, 2015, 40(3): 601-608.
30.	Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology, 2013, 57(5): 1962-1968.
31.	钱门宝, 朱慧慧, 陈颖丹, 等. 中国华支睾吸虫病药物治疗现状分析. 中国血吸虫病防治杂志, 2018, 30(5): 513-517.
32.	Qian MB, Yap P, Yang YC, et al. Efficacy and safety of tribendimidine against Clonorchis sinensis. Clin Infect Dis, 2013, 56(7): e76-e82. doi: 10.1093/cid/cis1011.

1. Chelomina GN. Clonorchiasis: global and regional epidemiology. Med Parazitol (Mosk), 2017, (2): 55-62.
2. Qian MB, Utzinger J, Keiser J, et al. Clonorchiasis. Lancet, 2016, 387(10020): 800-810.
3. Na BK, Pak JH, Hong SJ. Clonorchis sinensis and clonorchiasis. Acta Trop, 2020, 203: 105309. doi: 10.1016/j.actatropica.2019.105309.
4. Qian MB, Chen YD, Liang S, et al. The global epidemiology of clonorchiasis and its relation with cholangiocarcinoma. Infect Dis Poverty, 2012, 1(1): 4. doi: 10.1186/2049-9957-1-4.
5. Qian MB, Chen YD, Yan F. Time to tackle clonorchiasis in China. Infect Dis Poverty, 2013, 2(1): 4. doi: 10.1186/2049-9957-2-4.
6. Tang ZL, Huang Y, Yu XB. Current status and perspectives of clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and control. Infect Dis Poverty, 2016, 5(1): 71. doi: 10.1186/s40249-016-0166-1.
7. Miller WJ, Federle MP, Straub WH, et al. Budd-Chiari syndrome: imaging with pathologic correlation. Abdom Imaging, 1993, 18(4): 329-335.
8. DeLeve LD, Valla DC, Garcia-Tsao G, et al. Vascular disorders of the liver. Hepatology, 2009, 49(5): 1729-1764.
9. MacNicholas R, Olliff S, Elias E, et al. An update on the diagnosis and management of Budd-Chiari syndrome. Expert Rev Gastroenterol Hepatol, 2012, 6(6): 731-744.
10. Sharma A, Keshava SN, Eapen A, et al. An update on the management of Budd-Chiari syndrome. Dig Dis Sci, 2021, 66(6): 1780-1790.
11. Poisson J, Plessier A, Kiladjian JJ, et al. Selective testing for calreticulin gene mutations in patients with splanchnic vein thrombosis: A prospective cohort study. J Hepatol, 2017, 67(3): 501-507.
12. Valla DC. Hepatic venous outflow tract obstruction etiopathogenesis: Asia versus the West. J Gastroenterol Hepatol, 2004, 19(s7): S204-S211.
13. Menon KV, Shah V, Kamath PS. The Budd-Chiari syndrome. N Engl J Med, 2004, 350(6): 578-585.
14. Simonetto DA, Yang HY, Yin M, et al. Chronic passive venous congestion drives hepatic fibrogenesis via sinusoidal thrombosis and mechanical forces. Hepatology, 2015, 61(2): 648-659.
15. Cazals-Hatem D, Vilgrain V, Genin P, et al. Arterial and portal circulation and parenchymal changes in Budd-Chiari syndrome: a study in 17 explanted livers. Hepatology, 2003, 37(3): 510-519.
16. Orloff MJ, Isenberg JI, Wheeler HO, et al. Budd-Chiari syndrome revisited: 38 years’ experience with surgical portal decompression. J Gastrointest Surg, 2012, 16(2): 286-300.
17. Langlet P, Valla D. Is surgical portosystemic shunt the treatment of choice in Budd-Chiari syndrome? Acta Gastroenterol Belg, 2002, 65(3): 155-160.
18. Panis Y, Belghiti J, Valla D, et al. Portosystemic shunt in Budd-Chiari syndrome: long-term survival and factors affecting shunt patency in 25 patients in Western countries. Surgery, 1994, 115(3): 276-281.
19. Park JS, Federle MP, Sass DA. Education and imaging. Hepatobiliary and pancreatic: Budd-Chiari syndrome presenting as a caudate lobe pseudotumor. J Gastroenterol Hepatol, 2010, 25(1): 219. doi: 10.1111/j.1440-1746.2009.06096.x.
20. Han G, Qi X, Zhang W, et al. Percutaneous recanalization for Budd-Chiari syndrome: an 11-year retrospective study on patency and survival in 177 Chinese patients from a single center. Radiology, 2013, 266(2): 657-667.
21. Zhang CQ, Fu LN, Xu L, et al. Long-term effect of stent placement in 115 patients with Budd-Chiari syndrome. World J Gastroenterol, 2003, 9(11): 2587-2591.
22. Fu YF, Li Y, Cui YF, et al. Percutaneous recanalization for combined-type Budd-Chiari syndrome: strategy and long-term outcome. Abdom Imaging, 2015, 40(8): 3240-3247.
23. Cui YF, Fu YF, Li DC, et al. Percutaneous recanalization for hepatic vein-type Budd-Chiari syndrome: long-term patency and survival. Hepatol Int, 2016, 10(2): 363-369.
24. Jagtap N, Sharma M, Singh J, et al. Budd-Chiari syndrome: outcomes of endovascular intervention-A single-center experience. Indian J Gastroenterol, 2017, 36(3): 209-216.
25. Rathod K, Deshmukh H, Shukla A, et al. Endovascular treatment of Budd-Chiari syndrome: Single center experience. J Gastroenterol Hepatol, 2017, 32(1): 237-243.
26. Khan F, Armstrong MJ, Mehrzad H, et al. Review article: a multidisciplinary approach to the diagnosis and management of Budd-Chiari syndrome. Aliment Pharmacol Ther, 2019, 49(7): 840-863.
27. 王金淼, 梁晓宇, 陈岩, 等. 直接性肝内门腔静脉分流术治疗门静脉高压现状. 中华肝胆外科杂志, 2019, (1): 74-76.
28. Sun X, Qin T, Zhang J, et al. The outcomes of interventional treatment for Budd-Chiari syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis. Gastroenterol Hepatol, 2021, 44(6): 405-417.
29. Zhang F, Wang C, Li Y. The outcomes of interventional treatment for Budd-Chiari syndrome: systematic review and meta-analysis. Abdom Imaging, 2015, 40(3): 601-608.
30. Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology, 2013, 57(5): 1962-1968.
31. 钱门宝, 朱慧慧, 陈颖丹, 等. 中国华支睾吸虫病药物治疗现状分析. 中国血吸虫病防治杂志, 2018, 30(5): 513-517.
32. Qian MB, Yap P, Yang YC, et al. Efficacy and safety of tribendimidine against Clonorchis sinensis. Clin Infect Dis, 2013, 56(7): e76-e82. doi: 10.1093/cid/cis1011.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of a case of clonorchiasis with Budd-Chiari syndrome

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