Aster CMI Hospital have successfully treated a 29-year-old male patient suffering from advanced Budd-Chiari syndrome with liver decompensation and recurrent bleeding, using a high-risk Direct Intrahepatic Portosystemic Shunt (DIPS) procedure.
The patient first approached Aster CMI Hospital two years ago, where DIPS surgery was advised, but the family chose treatment at another hospital. There, IVC venoplasty and stenting were performed in April 2022, but DIPS was not done.
After the procedure, the patient developed repeated episodes of gastrointestinal bleeding, requiring endoscopic treatment. He again presented in April 2024 with severe variceal bleeding and later developed frequent ascites, infections, weakness, muscle loss, and intestinal bleeding.
In November 2025, the patient was admitted to Aster CMI Hospital in a critical condition with a high MELD score. After initial stabilization, the patient underwent technically challenging DIPS surgery performed through the previously placed IVC stent. The procedure took nearly three hours due to low portal vein flow and blood diversion to varices but was completed successfully.
Following surgery, the patient showed rapid improvement, was shifted from ICU to the ward, and discharged within a few days. After two months, the patient is walking normally, has no ascites or bleeding, is gaining weight, and his bilirubin has improved to 1.92, close to normal.
Dr. Nischal Kundaragi, Senior Consultant – Interventional Radiology, said:“This was a very high-risk case due to the patient’s poor liver condition and the presence of a previous IVC stent. Performing DIPS in such situations is complex, but timely intervention and team coordination helped achieve a positive outcome.”
Dr. Sonal Asthana, Lead Consultant – HPB & Liver Transplant Surgery, commented,“This case highlights how critical timely and advanced intervention can be in patients with complex liver vascular disorders like Budd-Chiari syndrome. Performing a DIPS procedure in a patient with advanced liver decompensation and a pre-existing IVC stent is extremely challenging and requires high levels of expertise and coordination.”