Liver transplantation for a renal transplantation recipient with secondary sclerosing cholangitis by choledochoduodenal fistula.
Choledochoduodenal fistula (CDF) complicated by peptic diseases or following surgical or endoscopic approaches of the common bile duct is not uncommon. However, it usually occurs without significant symptoms and can be well controlled with conservative treatment in normal immunized patients. Here we report a case involving a 58-year-old male patient with diabetic nephropathy, who received a choledocholithotomy for choledocholithiasis in November 2007 and renal transplantation in March 2008. The patient had recurring cholangitis during the 5 months following his renal transplantation. Cholangiography and liver biopsy revealed sclerosing cholangitis. The patient underwent liver transplantation (LT) in May 2009 because radiological and endoscopic procedures failed to control his jaundice. A proximal CDF was found during the LT procedures. We considered that the patient's advanced secondary sclerosing cholangitis was induced by this fistula. At the 16 months' follow-up, the patient was surviving well and the graft remained intact. To our knowledge, this is the first report of a renal transplantation recipient receiving LT because of uncontrolled cholangitis caused by a CDF.
Division of Hepatobiliarypancreatic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Wen-Tsan
WT
Chang
Niang-Cheng
NC
Lin
Cheng-Yuan
CY
Hsia
Chin-Su
CS
Liu
Hsin-Lin
HL
Tsai
Che-Chuan
CC
Loong
D001658:Biliary Fistula / Q000150:complications* / Q000175:diagnosis; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000175:diagnosis; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged