Sistema gastrointestinal y digestivo

Abstracto

Chronic Bile Duct Stenosis after Hepaticojejunostomy Requiring Re-Operation Leading to Liver Transplantation–A Case Report

Sebastian Cammann, Moritz Kleine1, Kai Timrott, Mark D. Jäger, Harald Schrem, Florian W. R. Vondran, Nicolas Richter1 and Hüseyin Bektas1

Background: Stenosis of a biliodigestive anastomosis is a rare complication of mid- and long-term survival after hepatobiliary surgery. First line therapy is endoscopic intervention. Only if this option is not successful or not possible a surgical approach is indicated.

Case Report: A 40 year old male patient presented with recurrent episodes of cholangitis after hepaticojejunostomy due to neuroendocrine tumor in the common bile duct more than 17 years ago. Advanced endoscopic techniques and percutaneous drainage failed to overcome this disorder resulting in subsequent surgical therapy. During the first operation the bile duct could not be found in order to create sufficient bile drainage. However, during preparation of the liver hilum the portal vein was inadvertently hurt. Following vessel reconstruction the patient suffered from recurrent thrombosis of the vein in the course and since the bile duct could not be identified and arrosion bleeding caused acute liver failure the patient was listed for liver transplantation. The latter was successfully performed allowing complete recovery of the patient.

Conclusion: In case of stenosis of a billiodigestive anastomosis and unsuccessful reconstruction of sufficient bile drainage despite extended surgical efforts or following complications during revision liver transplantation might be a good option for the treatment of patients in exceptional cases.