Acute Variceal Bleeding 11 Years After a Successful Mesoatrial Shunt for Budd-Chiari Syndrome - A Case Report

Sep 30, 2026

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A 31-year-old male underwent mesoatrial shunt surgery in July 2013 after recurrent abdominal pain led to a diagnosis of Budd-Chiari syndrome. He remained clinically stable for about 11 years without follow-up until May 2024, when acute variceal bleeding developed. He presented with haematemesis, melaena, and abdominal pain. After transfusion and resuscitation, endoscopic variceal banding was performed within 12 hours, followed by TIPSS at a higher centre. He was discharged in good condition.

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CategoryHealthcare

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Abstract

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Review began 11/20/2025 Review ended 12/01/2025 Published 12/07/2025 © Copyright 2025 Ali Elamin Babikir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98673 Open Access Case Report Acute Variceal Bleeding 11 Years After a Successful Mesoatrial Shunt for Budd-Chiari Syndrome: A Case Report Amira Ali Elamin Babikir 1 , Ammar Elnour 2 , Fatimaelzahra Salih 3, Nathan Kevin Peter 4, Hussameldin Mahdi 5 1. Surgery, National Health Service (NHS), London, GBR 2. Gastroenterology, Barking, Havering and Redbridge University Hospitals National Health Service (NHS) Trust, London, GBR 3. Acute and General Medicine, North Cumbria Integrated Care National Health Service (NHS) Foundation Trust, London, GBR 4. Acute and General Medicine, Barking, Havering and Redbridge University Hospitals National Health Service (NHS) Trust, London, GBR 5. Gastroenterology, Wrightington, Wigan and Leigh National Health Service (NHS) Trust, Manchester, GBR Corresponding author: Amira Ali Elamin Babikir, [amira.alielamin@gmail.com](amira.alielamin@gmail.com) Abstract A 31-year-old male patient underwent a mesoatrial shunt surgery in July 2013, after he presented with a few months ' history of recurrent abdominal pain and was subsequently diagnosed with Budd-Chiari syndrome. After the shunt surgery, he remained stable for around 11 years without any follow-up, until he presented to the hospital in May 2024 with acute variceal bleeding. The patient presented with haematemesis, abdominal pain, and melaena. He received a blood transfusion along with resuscitation measures and medical management for suspected acute variceal bleeding. He underwent endoscopic variceal banding successfully in less than 12 hours after his presentation. Eventually, he was referred to a higher centre where he underwent a transjugular intrahepatic portosystemic shunt (TIPSS) procedure and was eventually discharged home in good condition. In conclusion, mesoatrial shunt may still be considered as a viable treatment option for Budd-Chiari syndrome, when an experienced intervention radiologist for TIPSS or liver transplant is not available. Categories: Other, Cardiac/Thoracic/Vascular Surgery, Gastroenterology Keywords: budd chiari syndrome, endoscopy, mesoatrial shunt, tipss, variceal bleeding Introduction Budd-Chiari syndrome (BCS) is a rare but serious vascular disorder caused by the obstruction of hepatic venous outflow, leading to impaired blood drainage from the liver. This obstruction can occur at any level, from the small hepatic veins to the junction of the inferior vena cava (IVC) with the right atrium. The resulting elevated hepatic venous pressure causes liver congestion and dysfunction, which may progress to portal hypertension, cirrhosis, and ultimately liver failure [1-3]. The aetiology of BCS is diverse and includes hypercoagulable states (e.g., polycythaemia vera, antiphospholipid syndrome, and factor V Leiden mutation), local venous thrombosis, and external compression by tumours or cysts. In some cases, the cause remains idiopathic. Clinical presentation varies widely, ranging from asymptomatic cases to fulminant hepatic failure, depending on the extent and speed of venous occlusion [3-6]. Gastro-oesophageal varices haemorrhage constitutes the most dramatic and lethal complication of cirrhosis, variceal haemorrhage. Gastro-oesophageal varices are present in approximately 50% of cirrhotic patients [7] . Prognosis is highly variable and depends on the underlying cause and the degree of liver damage at diagnosis. Early detection and appropriately tailored therapeutic interventions are essential for improving outcomes [8-11]. Case Presentation A 31-year-old male patient presented to our hospital with a one-

FAQs

What condition did the patient have, and when was the mesoatrial shunt performed?

The patient had Budd-Chiari syndrome. Mesoatrial shunt surgery was performed in July 2013 after recurrent abdominal pain preceded the diagnosis.

What symptoms occurred when acute variceal bleeding presented?

He presented with haematemesis, melaena (black tarry stools), and generalised abdominal pain, with repeated episodes over one day.

How was the bleeding managed, and what procedure was done later?

He received blood transfusion and resuscitation, then underwent endoscopic variceal banding within 12 hours. He was subsequently referred for TIPSS at a higher centre and was discharged in good condition.

Sep 30, 2026

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