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Recognition and Treatment

William V. McDermott, MD, FACS; Paul M. Ridker, MD

Arch Surg. 1990;125(4):525-527.

Abstract
• In a review of 29 patients who were surgically treated by combined hepatic and portal decompression for intractable ascites, 18 were identified as falling into the category of the Budd-Chiari syndrome, with varying causes. Of this group, 2 patients were distinguised by the classical hepatic venous endophlebitis described by Chiari and later by Bras et al. Recently, this disease entity has been recognized as being due to the toxic effects of pyrrolizidine alkaloids contained in the Senecio and Crotolaria plants. In the first of these two cases the patient had emigrated from Jamaica and was exposed to "bush teas," but no chemical measurements were done. The second patient had consumed a large amount of comfrey teas, which were shown to contain high levels of pyrrolizidine alkaloids. These two cases add further weight to the existing evidence of the toxic effect of these alkaloids, and also demonstrate the effectiveness of hepatic and portal decompression.

(Arch Surg. 1990;125:525-527)

Author Affiliations
From the Department of Surgery, New England Deaconess Hospital, Boston, Mass (Dr McDermott); the Departments of Surgery (Dr McDermott) and Medicine (Dr Ridker), Harvard Medical School, Boston; and the Department of Medicine, Brigham and Women's Hospital, Boston (Dr Ridker).

Footnotes
Accepted for publication January 24, 1990.

Reprint requests to New England Deaconess Hospital, 110 Francis St, Suite 3A, Boston, MA 02215 (Dr McDermott).

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