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

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 pre- senting symptoms vary widely from mild ascites with slightly elevated liver function easily controlled by diuretics and anticoagulants, to acute liver failure requir- ing liver transplantation.