Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of "unexplained" anastomotic biliary stricture.

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Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of "unexplained" anastomotic biliary stricture.

Clin Transplant. 2016 Oct;30(10):1366-1369

Authors: Navez J, Golse N, Bancel B, Rode A, Ducerf C, Mezoughi S, Mohkam K, Mabrut JY

Abstract
BACKGROUND: Traumatic biliary neuromas (TBNs) represent a rare cause of biliary stricture (BS) after orthotopic liver transplantation (OLT). Diagnosis is challenging preoperatively and is most often made at pathology after resection. Herein, we report a 20-year experience of TBN-related BS.
PATIENTS AND METHODS: Medical records of 1030 adult patients undergoing OLT from 1991 to 2014 were reviewed. Patients with histologically proven TBN were identified among those presenting a BS.
RESULTS: Over the study period, 52 patients developed an anastomotic BS. Of these, 17 had repeat surgery and specimen examination identified TBN in five instances. All five patients with TBN had a duct-to-duct biliary reconstruction during OLT. Median delay from OLT to onset of symptoms was 69 months (range 4-239). Preoperative imaging showed a compressive mass in one patient. Four patients underwent TBN resection combined with hepaticojejunostomy and had an uneventful postoperative course. One patient underwent TBN resection and duct-to-duct reconstruction; he died from acute pancreatitis on postoperative day 21. After a median follow-up of 40.5 months (range 10-54), no recurrent BS occurred.
CONCLUSION: Traumatic biliary neuromas represent a possible diagnosis for unexplained anastomotic BS after OLT. Surgical excision combined with hepaticojejunostomy is effective, allows histological diagnosis, and prevents from recurrence.

PMID: 27411162 [PubMed - indexed for MEDLINE]

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