Get one’s dander up! The prime-aged man is skinny but has a belly as big as a drum, and his belly is full of large "earthworms"

The prime-aged man has slender limbs and thin bones, weighing only 46 kilograms, but his stomach is bulging as if he is pregnant with Liujia, and his belly is full of "earthworm-like veins", which turns out to be suffering from "Budd-Chia syndrome".

Before the operation, the stomach is bulging, and the blood vessels are coiled and bulging like earthworms.

Mr. Peng, 40, of Changsha, Hunan Province, has a five-year history of liver cirrhosis. In May 2023, he found that his belly appeared with coiled and raised blood vessels like earthworms, as well as mental malaise, loss of appetite, abdominal pain, bloating, and his weight dropped by nearly 5 kilograms in 10 days, and he came to the Department of Interventional Vascular Surgery of Hunan Provincial People's Hospital on June 5.

Inferior vena cava and hepatic venogram show inferior vena cava and hepatic vein occlusion with multiple lateral branch formation.

Fang Zhiyong, deputy chief physician of the Department of Interventional Vascular Surgery of Hunan Provincial People's Hospital, inquired about the history in detail and learned that he had recently continuously dissolved black stools, suspected gastrointestinal bleeding, and immediately improved CT examination for him, and the results showed that the inferior vena cava stenosis, hepatic vein occlusion, and multiple lateral branch formation. He was initially diagnosed with "Budd-Chia syndrome", and he was immediately admitted to the second ward of interventional vascular surgery for further treatment.

"Due to the obstruction of the blood flow output of the liver, blood accumulates in the liver, resulting in hepatosplenomegaly, cirrhosis, ascites, superficial varicose veins of the chest and abdominal wall, portal hypertension and other symptoms, and people are also emaciated due to decreased albumin synthesis, malnutrition, and increased fluid accumulation in the abdominal cavity." Deputy Chief Physician Fang Zhiyong said that if left untreated, portal hypertension will further aggravate, and Mr. Peng will face serious consequences of esophageal and gastric variceal bleeding, hepatic encephalopathy, liver failure and even death.

Fang Zhiyong, deputy chief physician of the Provincial Medical Interventional Vascular Surgery Department, and Tan Jie, attending physician, operated on the patient.

After clarifying the diagnosis and thoroughly evaluating the condition, the medical team decided to perform hepatic vein, inferior vena cava angiography, and angioplasty for him. On June 9, Deputy Chief Physician Fang Zhiyong and Attending Physician Tan Jie spent less than 2 hours using only a few small balloons to open the occluded hepatic vein and inferior vena cava for him, restoring the blood circulation of the liver and instantly reducing the pressure in the abdominal cavity.

On the way out of the operating room, Mr. Peng excitedly told the doctor: "I have never felt so relaxed, and I have a feeling of being instantly opened to Ren Du's second pulse."

1 day after the operation, the stomach bulging and varicose veins improved significantly.

Reimaging after balloon dilation showed smooth blood flow to the inferior vena cava and hepatic veins.

The medical staff of the second ward of the provincial interventional vascular surgery department check the patient's postoperative condition.

After the operation, Mr. Peng's abdominal varicose veins were significantly reduced, he was able to get out of bed the next day, and the surgical wound with a large needle eye was almost invisible, and he was successfully discharged from the hospital on June 13.

Fang Zhiyong, deputy chief physician of the Department of Interventional Vascular Surgery of Hunan Provincial People's Hospital, said that the causes of Budd-Chia syndrome are complex and diverse, such as Mr. Peng, patients with congenital abnormal development of inferior vena cava or hepatic vein, trauma leading to hepatic vein or inferior vena cava intimal injury, tumor invasion of liver vein, blood hypercoagulability leading to hepatic vein thrombosis, etc., are all causative factors of Budd-Chia syndrome. He reminded that trauma should be avoided as much as possible in life, and tumor patients should actively control the primary disease; If there is an unexplained decline in liver function, hepatic ascites and varicose veins of the abdominal wall, you should seek medical attention in time.

(Edit ZS.) ）

Hunan Medical Chat Special Author: Hunan Provincial People's Hospital Liang Hui Long Yao Photo/Hu Qin