*20-year-old Oluwatosin Ojelabi’s battle with Budd-Chiari syndrome
By Sola Ogundipe
For five years, Oluwatosin Ojelabi, 20, battled Budd-Chiari syndrome, a rare but deadly abnormality of the liver. Her life was one big misery until March 6, 2019, when she underwent a life-saving surgery that brought long expected relief.
Tosin is a beneficiary of a sophisticated liver-bypass surgery through a procedure called, Transjugular Intrahepatic Portosystemic Shunt (TIPS) performed for the first time in Nigeria or sub-Saharan Africa. The medical feat through minimally invasive surgery was performed by a team of local medical specialists at Euracare Multi-speciality Hospital, Lagos.
“I was 15 and in high school in Ibadan when I was diagnosed,” Tosin remarked during an encounter. “It was in the first year of Senior Secondary School (SSS 1), that I noticed my legs were unusually swollen, but I thought it was because I was not moving around much since I had a habit of sitting in class a lot.
“I thought nothing of it, but as time went on my abdomen began to swell up too. My belly got bigger and bigger and I looked like a pregnant woman. I also had severe constipation. It was a strange development and I was taken to the hospital.”
Surprisingly, the first doctor who examined Tosin in a private hospital didn’t find anything wrong. He dismissed the symptoms and assured her it would pass, giving her a clean bill of health. But Tosin didn’t get better, on the contrary her condition got worse.
“My abdomen got swollen even more. I was referred to another hospital, and then to the University College Hospital, UCH, Ibadan. But the doctors there did not really know what was wrong with me either. Was it my heart, kidneys or liver? They couldn’t really tell. They carried out test after test, but could not diagnose the problem.”
Tosin was having a lot of fluid accumulating in her distended abdomen. About 33 litres of fluid was being drained from her belly monthly. She carried the protruding belly around for the next couple of years. Her life was anything but normal during this period and could best be described as a living hell.
“Everything about normal life was completely disrupted. This illness affected me a lot. I didn’t have peace, I felt heavy like a pregnant woman. I could not go out, couldn’t attend parties, and couldn’t socialise. I couldn’t do anything normal.
“All my friends left me behind, I was either at home or in the hospital and rarely went to school because I got tired very easily. Besides most of those in my school did not actually understand what was happening to me.
“I managed to write my final school certificate exams during this time even as I continued battling the problem. Two years later, the hospital came up with a diagnosis of ascites, but even then the doctors were not certain what had caused it. I continued going in and out of hospital for the next three years, and was placed on drugs.”
Eventually, Tosin went through yet another test that revealed an issue with her hepatic portal vein and Budd-Chiari syndrome. “At that point, I was referred to a surgeon and that was how I met Dr Hammed Ninalowo, an intervention radiologist who examined me and offered to help. I found my way to Euracare Specialist Hospital through him.”
According to medical literature, Budd–Chiari syndrome is a very rare condition, affecting one-in-a-million adults. The condition is caused by blockage of the hepatic veins that drain the liver. The common symptoms are abdominal pain, ascites (accumulated fluid) and liver enlargement.
Without treatment, the condition is fatal due to progressive liver failure within three years from the time of diagnosis. Following treatment however, the survival rate for patients is quite good.
Euracare successfully performed the TIPS shunt utilising modified techniques with thinking outside the box, but the expertise was available to ensure success. A US-trained Vascular and Interventional Radiologist with subspecialty training in interventional oncology, Ninalowo led the medical team through the five-and-a-half hour surgery.
“It’s exciting to be able to perform the first TIPS procedure in Nigeria,” he said, giving a detailed description of the disorder. “Budd-Chiari syndrome as a disease where there is obstruction of the venous outflow from the liver either at the level of the hepatic veins (blood vessels that carry blood out of the liver) or the inferior vena cava (the big blood vessel that carries blood back to the heart).
“When this obstruction occurs, all the blood coming from the abdominal organs and bowels into the liver are obatructed resulting in congestion of the liver and backflow of blood into the abdomen. This pressure results in massive fluid build-up in the abdomen called ascites. In the past, the only way to treat Budd-Chiari syndrome was a large operation with surgery creating ‘a mesocaval shunt,’ a shunt from the big veins in the belly to the inferior vena cava.
“Our patient did well and was discharged home the next morning. This procedure was only previously done with a major operation, which would have required time in the intensive care unit and significant hospitalisation time after surgery if she survived the stress to her already weak state. We have followed up with her and we are very encouraged by her progress.
“What was found was that because of how sick these patients were, a lot of them did not survive
an operation due to baseline portal hypertension. The other definitive treatment is liver transplant.
“We in interventional radiology have a revolutionary procedure called a TIPS, which is done by very tiny pinhole access into one of the veins in the neck. The whole procedure is performed under X-ray guidance through this access. The TIPS is done by placing a stent graft (bypass tube) between the big vein in the abdomen and the veins taking blood away from the liver essentially bypassing the liver. “
The Medical Director, Euracare Multispeciality Hospital, Lagos, Dr Tosin Majekodunmi described the success of the procedure is testament to the hospital’s innovation and professionalism and the commitment to reducing medical tourism by Nigerians.
“As the leading multi-specialist hospital in Nigeria, we are committed to providing excellent care for our patients and procedures like TIPS, which requires complex interventional radiology allow us to showcase our expertise especially to people who normally would prefer to travel abroad for procedures.”
Tosin had never undergone surgery previously and was scared initially. “I was 100 percent scared, really scared because I realised I would be asleep all through and my fear was that I might not wake up again. I slept all through the surgery. I just woke up after 16-17 hours and everything was over. Now the surgery has been done, I’m a survivor.
“There is a huge difference in quality of life for me now. Previously I was looking malnourished with an abnormally big belly, but now I have my body back. Then I could not eat or drink but now I eat normally. It was terrible a terrible experience. I’m so glad it’s over.”
Tosin confessed she learned a lot from the experience. “I realised I have a very strong supportive system, my father and aunties supported me and there were times I wanted to give up, they encouraged me to go on.
“I learned that no matter what you are going through, you should never give up. I suffered for five years. My mates are in 300 level now but I’m glad to be alive and moving on.”
Tosin’s greatest wish is to return to school. “School is the next thing for me, definitely. Now I’m fully recovered, I plan on writing my JAMB exam next year and hopefully I’ll gain admission. I want to set up a Foundation to help people with this situation and to encourage them never to give up because I’ve been there. There is solution for this challenge.”