Julie Navez1, Nicolas Golse1, Brigitte Bancel2, Agnès Rode3, Christian Ducerf1, Salim Mezoughi1, Kayvan Mohkam4,5, Jean-Yves Mabrut1,6. 1. Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France. 2. Department of Pathology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France. 3. Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France. 4. Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France. kayvan.mohkam@chu-lyon.fr. 5. Université Claude Bernard Lyon 1, EMR 3738, EDISS 205, Lyon, France. kayvan.mohkam@chu-lyon.fr. 6. Université Claude Bernard Lyon 1, EMR 3738, EDISS 205, Lyon, France.
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.
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.
Authors: Priti Lalchandani; Abraham Korn; Jiajie G Lu; Samuel W French; Linda Hou; Kathryn T Chen Journal: Ann Hepatobiliary Pancreat Surg Date: 2019-08-30