BackgroundHepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results.Case presentationA 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt.ConclusionAt five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.
Neurological complications of gastrointestinal endoscopy are extremely rare; cerebral air embolism has been described and can be severe and fatal. A high index of suspicion for an air embolism is a must in case of procedural or periprocedural cardiopulmonary instability and neurologic symptoms, particularly in patients with recognized risk factors. The diagnosis of an air embolism is often difficult and is complicated by the fact that air may be rapidly absorbed from the circulation. Simple maneuvers to decrease the impact of a potential air embolism include; stopping the procedure, administering high flow 100% oxygen, placing the patient in Trendelenburg and left lateral decubitus position, and discontinuing nitrous oxide. C T Scan and 2 D ECHO are important diagnostic tests.
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