Syndrome d'obstruction sinusoïdale (maladie veino-occlusive)

The sinusoidal obstruction syndrome (SOS or veno-occlusive disease) usually corresponds to lesions of hepatic sinusoidal cells followed by an obstruction of centrolobular veins. Historically, the first cases were described with the toxicity of pyrrolizidine alkaloids. SOS cases have been described associated with a lot of drugs. Among them, oxaliplatin, an anticancerous drug used for the treatment of colorectal cancers has been recently incriminated. Nevertheless, the most frequent situation is after bone marrow transplantation with typically an icteric cholestasis, an ascites and a painless hepatomegaly for 20 days post-transplantation. These simple clinico-biological criteria are usually sufficient for the diagnosis in the majority of cases. However, the liver biopsy by transjugular route is necessary in atypical forms. The prognosis is variable, correlated with the degree of clinico-biological manifestations and of portal hypertension. The mortality is elevated in the severe forms. There is no clear consensus for the treatment of SOS. Preventive treatments call for anticoagulation drugs, ursodeoxycholic acid, defibrotide and precursors of gluthation. The benefit of defibrotide or anticoagulation drugs for curative treatments have to be demonstrated.