Late Biliary Stricture after Liver Transplantation
Posted in Pictures on 27 October 2014
José Fuster (Hepatobiliary surgery and Liver Transplant Senior Consultant)
Gabriel Díaz (Gastrointestinal Surgery Specialist)
Hospital Clínic, Barcelona, Spain
A 60 year old male with a history of elective liver transplant due to cirrhosis developed after autoimmune hepatitis (donor died of a stroke at 61 years old, end-to-end biliary anastomosis without kher and correct intra operative cholangiography) presented with cholestasis 3 years after liver transplantation.
A cholangiography by MRI (FIG. 1) was performed showing a dilatation of the intra/extrahepatic ducts and a stenosis of the anastomosis without choledocholithiasis, the liver parenchyma was normal.
A ERCP was done showing a “S” shaped biliary tract that could not be cannulated so endoscopic treatment was not possible. The next step for the treatment was surgery performed by open approach, the biliary anastomosis looked fibrotic and was resected, then a Roux-en-Y hepaticojejunostomy was used to rebuild the bilis transit using a monofilament absorbable running suture for the posterior layer and separated knots for the anterior.
Throughout the postoperative period there was no leak, pathological examination of the anastomosis was compatible with fibrosis and liver biopsy was unspecific. A year and a half after surgery the patient’s liver function is normal with complete resolution of the cholestasis.