Acute Onset Budd-Chiari Syndrome in the Postpartum Period: A Case of Missed Diagnosis Leading to Rapid Deterioration

Budd-Chiari syndrome (BCS), a rare hepatic vein obstruction condition, poses significant risks during gestation and the postpartum period. We present the case of a 30-year-old primigravida at 32 weeks gestation admitted with weakness and lethargy, which was diagnosed with impending uterine rupture, HELLP syndrome, and intrauterine fetal demise. An emergency cesarean section was performed, delivering a stillborn baby and uncovering 700 milliliters of blood clots in her abdominal cavity. Postoperatively, she experienced severe headaches, chest tightness, epigastric pain, nausea, vomiting, persistent fever, and abdominal distension, all of which were severe and persistent. Although treatment for sepsis and HELLP syndrome was initiated, BCS was eventually confirmed through ultrasound and Doppler sonography, though advanced imaging techniques were limited. Aggressive treatment with antibiotics and supportive care could not prevent worsening liver function, leading to severe bradycardia and death within five days. This case underscores the necessity of prompt recognition and multidisciplinary management of BCS among pregnant and postpartum women to improve outcomes in this rare yet critical condition.