A Rare Liver Complication of Ulcerative Colitis in a Child

 

Presenter: Mounika Bazar

Affiliation: Kanchi Kamakoti Child's Trust Hospital, India

Presentation Type: Oral Presentation (Virtual)

Title: Budd–chiari syndrome as an extraintestinal manifestation of ulcerative colitis in a child

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🧠 Understanding the Association

Ulcerative colitis (UC) is a chronic inflammatory bowel disease known for multiple extraintestinal manifestations. Although hepatic involvement can occur, Budd–Chiari syndrome (BCS) is an exceptionally rare and potentially life-threatening complication in children. BCS results from obstruction of hepatic venous outflow and may remain clinically silent until advanced liver disease develops.

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👦 The Clinical Story

We report the case of a 12-year-old boy diagnosed with UC after colonoscopy and histopathological confirmation of pancolitis.

He was initially treated with:

·         💉 Intravenous corticosteroids

·         💊 Oral steroids

·         🌿 Mesalamine

·         🧬 Azathioprine

The child showed good symptomatic improvement and entered clinical remission.

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🔍 An Unexpected Finding

During routine follow-up one year later, abdominal ultrasonography revealed coarse liver echotexture and nodularity—despite:

·         ✅ Normal liver function tests

·         ✅ Normal coagulation profile

This prompted further evaluation with liver biopsy, contrast-enhanced CT scan, and Doppler studies.

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🧪 Diagnostic Confirmation

Liver biopsy demonstrated cirrhosis characterized by lobular distortion, sinusoidal dilatation, and venous intimal fibrosis.

Imaging findings included:

·         Hepatomegaly

·         Caudate lobe hypertrophy

·         Narrowing of intrahepatic inferior vena cava and hepatic veins

·         Collateral vessel formation

These features confirmed chronic Budd–Chiari syndrome.

A detailed hypercoagulable work-up was negative, except for low-titer ANA positivity.

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🩺 Management & Outcome

The child was diagnosed with compensated cirrhosis and started on anticoagulation therapy.

Interventional radiology-guided angioplasty was successfully performed to relieve venous obstruction. He remains stable under close multidisciplinary follow-up involving pediatric gastroenterology, hepatology, and radiology teams.

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🌟 Key Takeaways

·         BCS is a rare but serious extraintestinal manifestation of Ulcerative colitis in children.

·         Subtle imaging abnormalities may precede biochemical derangements.

·         Early Doppler evaluation is essential even when liver function tests are normal.

·         Prompt multidisciplinary intervention can prevent progression to hepatic decompensation.

 

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👩⚕️ About the Speaker

Dr. Mounika Bazar, from India, has completed advanced training in Pediatric Gastroenterology, Hepatology, and Nutrition and is actively engaged in clinical practice and academic work. She has presented her research at national and international conferences and contributes to academic writing and clinical research. Her work reflects a commitment to academic excellence, with an evolving focus on healthcare systems, quality improvement, and medical education.

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🌍 Join the Global Conversation

Event: International Conference on Pediatrics, Neonatology & Child Health
📅 March 26–28, 2026
📍 Singapore & Online
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