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Meurisse N, Pirenne J, Monbaliu D. Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report. Int J Surg Case Rep. 2017;41:200-204doi: 10.1016/j.ijscr.2017.09.031.
Meurisse, N., Pirenne, J., & Monbaliu, D. (2017). Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report. International journal of surgery case reports, 41200-204. https://doi.org/10.1016/j.ijscr.2017.09.031
Meurisse, Nicolas, et al. "Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report." International journal of surgery case reports vol. 41 (2017): 200-204. doi: https://doi.org/10.1016/j.ijscr.2017.09.031
Meurisse N, Pirenne J, Monbaliu D. Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report. Int J Surg Case Rep. 2017;41:200-204. doi: 10.1016/j.ijscr.2017.09.031. Epub 2017 Oct 26. PMID: 29096343; PMCID: PMC5686042.
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Int J Surg Case Rep. 2017;41:200-204. doi: 10.1016/j.ijscr.2017.09.031. Epub 2017 Oct 26.

Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report.

International journal of surgery case reports

Nicolas Meurisse, Jacques Pirenne, Diethard Monbaliu

Affiliations

  1. Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
  2. Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, & Department of Microbiology and Immunology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: [email protected].

PMID: 29096343 PMCID: PMC5686042 DOI: 10.1016/j.ijscr.2017.09.031

Abstract

INTRODUCTION: Non-anastomotic biliary strictures (NAS) represent a major cause of morbidity, graft loss, and mortality after liver transplantation (LTx). NAS can result from an ischemic/immune-mediated injury, or from the cytotoxic effect that bile salts have on the biliary mucosa under hypothermic conditions. For this reason it is crucial to flush the bile duct at the time of procurement.

PRESENTATION OF CASE: We report a case of an imported liver with an accidentally ligated and subsequently completely unflushed common bile duct. The recipient was a 60 year-old man suffering from hepatocellular carcinoma and post-alcoholic cirrhosis. Post-operative course was uneventful and the patient was discharged after 18days. Within 2 months post-transplantation, a rapidly evolving cholestasis was diagnosed. Endoscopic-retrograde-cholangio-pancreaticography revealed diffuse NAS. Due to the rapid clinical and biochemical deterioration there was no other option than re-transplantation.

DISCUSSION: Suboptimally flushed bile ducts are often encountered and represent a risk factor for NAS after LTx. This unique case represented an extreme form where the biliary tree was not flushed at all. The dilemma of this unforeseen situation raised the question to transplant or discard this liver for transplantation? Given the organ shortage, the pressure to use less-than-ideal organs, the otherwise normal aspect of the liver and our incapacity to predict with certainty the development (or not) of NAS, we accepted this liver for transplantation.

CONCLUSION: This case illustrates a contrario the importance of flushing the bile duct and risk of extensive dissection of the hepatic hilum at the time of procurement.

Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Keywords: Bile ducts flush; Case report; Liver transplantation; Non-anastomotic biliary strictures

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