The use of biliay stents in liver transplantation (LT) has been always controversial; hereby by we report a late stent-induced complication 12 years following LT.
Case Report: We report a 14 years old girl who suffered from biliary atresia since birth; and at the age of 3 she underwent cadaveric liver transplantation in which a small plastic catheter was used to stent the Roux-en-Y hepaticojejunostomy. Following her transplant she was admitted several times with a clinical picture suggestive of cholangitis. Most recently she presented to our Emergency with high-grade fever, jaundice and rigors. Laboratory investigation showed markedly elevated bilirubin and liver enzymes. Doppler US examination confirmed patency of all vessels and minimal biliary dilatation. Plain abdominal X ray showed a sausage shaped shadow surrounding a radio-opaque tube located in the central abdomen. Percutaneous-Transhepatic-Cholangiogram (PTC) showed a widely patent hepaticojejunostomy; however, the roux-en-Y jejunal loop looked dilated with a large filling defect obstructing its distal end (nearby the enetro-enterostomy). CT scan showed a large sausage-shaped mass surrounding a central dense line a located within a bowel loop. The patient was taken to the operating room and large sausage- shaped stone (7x2.5x2.7 cm) was surgically removed from the distal portion of the Roux-en-Y jejunal loop, this stone was obstructing the Roux loop at the site of entero-enteric anastomosis. Examination of the stone showed that it was a large mixed stone (Calcium Palmitate 50% and Bilirubin 50%) formed around a 5 cm plastic biliary stent. This can be explained by the failure of the plastic stent to migrate through the distal end of Roux-en- jejunal loop where it was impacted and acted as a nidus for formation of this giant stone over a 12 years period following LT. Following the procedure her liver functions normalized and up till now the patient did not suffer form any further attacks of cholangitis. We believe that the use of biliary stents during liver transplantation should be kept to the minimum in order to avoid the possible morbidity related to their failure to migrate and pass naturally after LT.