Budd-Chiari Syndrome Induced by Stage IV Rectal Carcinoid

Abstract Budd-Chiari syndrome (BCS) is defined as an obstruction of the hepatic venous outflow anywhere from the small hepatic veins to the suprahepatic inferior vena cava. In this study, a rare case of BCS induced by a metastatic rectal carcinoid is presented. A 57-year-old African American woman with stage IV rectal carcinoid presented with right upper quadrant pain, associated with decreased appetite and weight loss >13 kg over 2 months. Computed tomography scan with contrast enhancement revealed filling defects in the left and middle hepatic veins extending into the suprahepatic inferior vena cava to the junction of the right atrium, suggesting BCS. Thrombophilia workup was negative, and no signs of liver cirrhosis or portal hypertension were found. A hepatitis profile workup yielded negative results. This is the first reported case of BCS that is associated with a metastatic rectal carcinoid. More research is needed to identify the mechanism leading to thrombogenesis in carcinoid tumors.