We present a 3-year-old child with Budd Chiari syndrome having idiopathic complete occlusion of all three major hepatic veins and small hepatic venules. Adequate antegrade flow in right hepatic vein was established by transfemoral balloon angioplasty followed by stenting of the same. Long term antiplatelet therapy was instituted. Medium term follow up reveals satisfactory antegrade flow and regression of symptoms. This strategy highlights an effective nonsurgical approach of restoring physiological pattern of hepatic sinusoidal blood flow in Budd Chiari syndrome.
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