Clinical features of sinusoidal obstruction syndrome: an analysis of 35 cases and literature review

Objective To summarize the clinical features, diagnosis, and treatment of sinusoidal obstruction syndrome ( SOS) and review relevant literature and to improve the clinical diagnosis of this disease. Methods A retrospective analysis was performed on the medical histories, clinical manifestations, laboratory results, imaging findings, liver histopathology, treatments, and prognosis of 35 patients with SOS who were hospitalized at the First Affiliated Hospital of Nanjing Medical University from August 2008 to May 2013. Results Of all patients, 31 ( 88. 6%) had taken Gynura segetum, 2 had received other traditional Chinese medicines, and 2 had undergone allogeneic hematopoietic stem cell transplantation. The main symptoms included abdominal distention ( 100%) , ascites ( 91. 4%) , hepatalgia ( 62. 9%) , and jaundice ( 48. 6%) , as well as varying degrees of liver function damage. Ultrasound examination revealed unclear or thinner hepatic veins and slower or no blood flow. CT scans showed map-like heterogeneous enhancement in the liver. Pathological examination demonstrated local sinusoidal congestion, steatosis of some hepatocytes, hemorrhage in some liver tissue, and massive chronic inflammatory cell infiltration in the liver tissue and portal area. After treatment, 15 cases ( 42. 9%) showed improvement, and 20 cases ( 57. 1%) showed no response and were discharged. Conclusion Taking Gynura segetum is still the main cause of SOS in China. Early diagnosis and timely use of drugs for improving hepatic microcirculation and glucocorticoids are effective in improving the prognosis of SOS.