Traumatic neuroma of extrahepatic bile ducts after orthotopic liver transplantation.
Traumatic neuromas (TN) of the biliary tree causing strictures have only occasionally been described after liver transplantation. Herein, we have reported 15 cases of TN that were detected between 1 and 17 months after transplantation (median: 4 months) during surgery for obstructive jaundice (12 cases), after alterations of liver function tests (two cases), or incidentally discovered after retransplantation (n = 1) we resected the lesion and the biliary anastomosis. Pathological examination and immunostaining for S-100 protein were performed to study the nerve fascicles. After a median follow-up time of 64 months (range = 0-127), 10 patients are alive without any complication related to the previous biliary TN. We propose the following classification: type I: TN originating from and located in the main biliary tract wall, and type II: TN arising from the surrounding tissues next to the main biliary tract. We conclude that TN are not uncommon after liver transplantation and that they are sometimes symptomatic, causing a biliary stricture that requires surgical treatment. We propose a classification to help patient selection for surgery. In our opinion, resection of the TN is the operation of choice, together with resection of the involved biliary tract in type I TN.
Liver Transplantation Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain. herrera@humv.es
L
L
Herrera
E
E
Martino
J C
JC
Rodríguez-Sanjuán
J
J
Castillo
F
F
Casafont
F
F
González
J
J
Figols
J
J
Casanueva
M
M
Cagigas
M
M
Gómez-Fleitas
D000293:Adolescent; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D017734:Bile Ducts, Extrahepatic; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D007166:Immunosuppressive Agents