Surgery, Gastroenterology and Oncology

Introduction: Budd-Chiari syndrome associated with inferior vena cava (IVC) thrombosis extended to the right atrium is a rare condition, which requires liver transplantation with different techniques of caval reconstruction. The procedure is technically demanding, especially if it is performed solely transdiaphragmatically.

Case presentation: An orthotopic liver transplantation (OLT) was performed in April 2014 in a 24-year old male patient with Budd-Chiari syndrome due to idiopathic thrombophilia and complete thrombosis of the retrohepatic IVC, up to its intrapericardic portion. Due to the impossibility of performing a cavo-caval anastomosis, a transdiaphragmatic anastomosis between the recipient right atrium and the donor superior cuff of the IVC was performed, without sternotomy.

Results: Postoperative course was uneventful except for persitent ascites, which was successfully managed with diuretics. The patient was discharged after 34 days; 9 months postoperatively he has optimal liver function and has returned to normal life.

Conclusion: A transdiaphragmatic cavo-atrial anastomosis represents a feasible option in the setting of OLT, when the recipient IVC cannot be used due to extensive thrombosis, especially if it is performed by a multidisciplinary operative team.

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