A CASE OF CHRONIC BUDD CHIARI SYNDROME WITH SPONTANEOUS BACTERIAL PERITONITIS.

A 32 year old female, delivered 14 months back, presented with progressive abdominal distension, abdominal discomfort and fever of 10 days duration, with past history of admission in a general hospital for 1 month, with complaints of pain right upper abdomen and jaundice. Examination revealed fever, tachycardia and melasma .She had a distended abdomen with sriae and visible veins on both flanks, hepatomegaly and fluid thrill. Rest of the examination was unremarkable. Investigations revealed anemia (normochromic, normocytic) with high ESR. In liver function , she had increased bilirubin and transaminases and hypoalbuminemia. Ascitic fluid analysis showed neutrophillic,culture negative and low SAAG ascites. Abdominal imaging showed hepatic vein thrombosis extending into inferior vena cava with collaterals. Coagulation profile showed Protein C and Protein S deficiency.