A complex surgery using internal x-rays was recently performed successfully at Sheikh Khalifa Medical City by the Cleveland Clinic on a 20-year-old patient with Budd-Chiari syndrome (venous obstruction in the liver). After traveling to Singapore for urgent treatment, the patient returned to Abu Dhabi, where she resides, and went to Al Mafraq Hospital due to her suffering as a result of the disease.
After her condition stabilized and her correct diagnosis was made in the hospital, Mafraq Hospital transferred her to Sheikh Khalifa Medical City because she needed a complex surgery that saved her life. It is worth noting that both Sheikh Khalifa Medical City and Mafraq Hospital are part of the facilities of the Abu Dhabi Health Services Company "SEHA", which is responsible for all treatment activities in government hospitals and clinics in the Emirate of Abu Dhabi.
The patient, (Palestine), was suffering from severe obstruction of her hepatic veins and some branches of the portal vein, a huge accumulation of fluid in her abdomen, malnutrition, in addition to jaundice. Neck vein), where an artificial channel is made in the liver using blood vessels taken from the patient himself. .
During this surgery, the doctor connects a high-pressure vein in the liver (the portal vein) to the systemic (minimal) circulation of the low-pressure veins, thereby releasing the pressure from the abdominal veins.
By creating this "connection", a large amount of pressure on the liver cells is reduced, and the enlarged varicose veins disappear, which is a collection of swollen veins similar to varicose veins, except that they are located inside the abdomen and in the esophagus, and the fluid accumulated within the abdominal cavity begins to shrink. Therefore, the risk of fatal gastro-intestinal bleeding disappears, the symptoms of flatulence improve, and the patient's condition improves with improved liver function.
The patient first went to a state-of-the-art medical center in Singapore, but unfortunately the doctors there were not able to place the joint, and the operation was considered too complicated due to the presence of thrombosis in the portal vein or blockage of the vein due to blood clotting. Instead, the fluid was drained from the abdomen in an ancient method that relied on placing a tube through the esophagus that drained fluid into the superior vena cava directly into the heart.
Then the patient returned to her home in Abu Dhabi, and visited Al Mafraq Hospital, a health facility near which she lives. The doctors there discovered that a clot had formed around the discharge tube and moved to the pulmonary veins, threatening her life. This blocked one of the small branches of the pulmonary veins that feed the lungs, causing shortness of breath. After the patient’s condition was stabilized at Al Mafraq Hospital, she was transferred to Sheikh Khalifa Medical City for surgery to connect the portal circulation within the liver through the jugular vein, as Sheikh Khalifa Medical City is the main center for performing such surgery in the country.
In the Medical City, Dr. Muhammad Al-Zaabi, a liver transplant and transplant consultant, admitted the patient to the hospital and reassessed her health condition. After several medical analyzes, the doctors decided to perform a surgery to connect the portal circulation within the liver through the jugular vein to see if venous clots formed, and to remove the old drainage tube, And then start giving an effective blood-thinning drug before letting her out of the hospital.
A multidisciplinary team contributed to the treatment of the patient during her stay in the hospital, and this team included a hepatologist, interventional radiologist, hepatobiliary and biliary surgeons, hematologists, in addition to a large number of specialists, residents, and intensive care specialists, nurses, social workers, and pharmacists.
This complex operation was performed by Dr. Jamal Al-Qutaish, Consultant Interventional Radiologist at Sheikh Khalifa Medical City, which lasted approximately two and a half hours. The process of placing the joint was very complicated because of thrombosis in the portal venous system, but thanks to great skill and great perseverance, the operation was successfully completed without complications.
Dr. Mohammed Al Zaabi stated, “This surgery not only saved the patient’s life, but also contributed to a great improvement in her lifestyle. It required skilled hands due to the presence of thrombosis in the portal vein. Only a few operations were performed in these same complications and conditions to connect the blood circulation Hepatobiliary portal through the jugular vein around the world. I am confident that we are fortunate to have Dr. Jamal Al-Qutaish with us on the medical team.”
Dr. Jamal Al-Qutaish said, "The varicose veins in the patient's stomach and esophagus disappeared immediately, and her yellow eyes regained their white color, and she began to eat food better, and the fluids from her stomach gradually disappeared.
Over the next few months, her nutrition improved dramatically as she gained an average of 10kg. Her fiancé came from Gaza in Palestine to support her and raise her morale during this period.” Dr. Al-Qutaish commented, “We are very satisfied to see her parents, who were very anxious and frustrated before the operation, and now they are very happy and happy.”
Dr. Al-Qutaish added: “The surgery was carried out successfully without complications through a very small incision (less than 5 mm) at the base of the patient’s neck. It was performed using partial anesthesia and took two and a half hours. The patient is now in good health and we come back every once in a while for comprehensive checks. To perform the surgery to connect the portal circulation within the liver through the jugular vein in the Medical City for several cases and health problems for adults and children. Performing this surgery for this highly complex case is an achievement added to our experience, and this surgery is one of the few surgeries that have been successfully performed in the region.”
The patient was then discharged from the hospital after removing the old drainage tube, receiving nutritional and physical support, and after treating her blood to prevent future clotting and maintain blood flow in the new connection.
For his part, Mr. Karl Stanifer, CEO of Abu Dhabi Health Services Company - SEHA, said, "The continued expansion and continued success of medical and surgical care are two very important steps towards providing health care that is comparable to the best in the world. With this service, Sheikh Khalifa Medical City is able to To treat patients with Budd-Chiari syndrome and portal hypertension in the country instead of sending them abroad for treatment.As a result, we reduce the inconvenience of traveling abroad, surrounded by their family and community support they need, in addition to staying in the UAE The United States greatly increases the comfort of having the patient’s family next to him, and makes it easier for the patient to come for the review.”
Dr. Tej Maini, CEO of Medical City commented, “We continue to expand our capabilities to perform rare and complex procedures for our patients. In fact, the most important result for us and our doctors is to see the improvement in this woman’s life and to see her recover after treatment and come back .” To her home in good health.
On his part, Dr. Atul Mehta, Head of Medical Services Department at the Medical City said, “We started performing jugular intrahepatic portal surgery in 2007, which is a surgery performed on certain patients with portal hypertension with swelling of the gastro-oesophageal veins. A case of fluid accumulation that does not respond to treatment.
Since then the expert Interventional Radiologist, Dr. Jamal Al-Qutaish has performed more than 20 surgeries of this kind with the help of the highly qualified medical team. We are continuing our efforts to create and innovate new ways of caring for patients using pioneering procedures in the country similar to this procedure.”
It is noteworthy that the surgery to connect the portal circulation within the liver through the jugular vein is the most complex interventional radiology procedure, and it is considered a life-saving procedure for patients suffering from bleeding gastric and esophageal varices due to portal hypertension.
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