Endoscopic Management of Biliary Cast Syndrome Post Hepatic Trauma

TL;DR: A case in a non-transplant patient that is described almost exclusively in liver transplant patients is described, which is resolved with endoscopic approach of biliary casts.

Abstract: Submit Manuscript | http://medcraveonline.com been described almost exclusively in liver transplant patients, more often during the first years of orthotopic liver transplant, when graft preservation techniques were less advanced [1-3]. Nowadays, the prevalence of bile duct filling defects due to sludge or casts is reported to be around 3 % [4]. The casts can develop at any level of the biliary tree, either intra, extrahepatic or both. The exact pathogenesis of biliary casts is not well known but many factors have been suggested as playing an aetiological role in their formation. Probably the most important one is ischemia but many others can intervene, such as infection, ductal lesions, fasting, cyclosporine and in general any other factor that promotes increase in biliary viscosity and/ or hinders the flow of bile [5-8]. The treatment of this disorder can be endoscopic, through ERCP, with sphincterotomy and removal of the casts [9] but in many cases it is necessary to proceed to a surgical cleaning of the biliary tree [10]. Here we describe a case in a non-transplant patient that we resolved with endoscopic approach.