title: Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of "unexplained" anastomotic biliary stricture.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Navez
authors.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.affiliation: Department of Pathology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bancel
authors.affiliation: Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Rode
authors.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Ducerf
authors.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Salim
authors.initials: S
authors.lastname: Mezoughi
authors.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France. kayvan.mohkam@chu-lyon.fr.|Université Claude Bernard Lyon 1, EMR 3738, EDISS 205, Lyon, France. kayvan.mohkam@chu-lyon.fr.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Mohkam
authors.affiliation: Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.|Université Claude Bernard Lyon 1, EMR 3738, EDISS 205, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
mesh_terms: D000714:Anastomosis, Surgical; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries / Q000601:surgery*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D009463:Neuroma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: biliary stricture; duct-to-duct reconstruction; innervation of common bile duct; liver transplantation; traumatic neuroma