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

## TL;DR

A man who had a successful shunt surgery for Budd-Chiari syndrome 11 years ago experienced acute variceal bleeding and was treated with endoscopic and interventional procedures.

## Contribution

This case highlights the long-term outcomes and potential complications of mesoatrial shunt in Budd-Chiari syndrome.

## Key findings

- The patient remained stable for 11 years after mesoatrial shunt surgery.
- Acute variceal bleeding was successfully managed with endoscopic banding and TIPSS.
- Mesoatrial shunt remains a viable option when advanced interventions are unavailable.

## 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.