Abdominal pain and rectal bleeding as a complication of biliary stent migration in a liver transplant recipient

Abstract

Biliary tract problems frequently complicate liver transplantation, and Sir Roy Calne’s often quoted comment that biliary reconstruction is the “technical Achilles’ heel”1 of transplantation remains applicable. The incidence of biliary tract complications varies by center, but in recent series it ranges from 16% to 19%.2-4 Early complications (less than 30 days after transplantation) include bile leaks, sphincter dysfunction, and extrinsic obstruction. Late complications include anastomotic and intrahepatic strictures, as well as T-tube complications which can present early or late. The management of posttransplantation biliary complications will depend on the type of biliary reconstruction: roux-en-Y choledochojejunostomy versus choledochocholedochostomy (duct-to-duct). The former is not amenable to endoscopic management, but complications of a duct-to-duct anastomosis can often be managed by the endoscopist. Endoscopic retrograde cholangiography (ERCP), therefore, is often a useful technique in posttransplantation care, especially in the diagnosis and management of biliary anastomotic strictures.5 We report an unusual complication of therapeutic endoscopic management of a posttransplantation biliary anastomotic stricture resulting in abdominal pain and rectal bleeding. To our knowledge, a similar clinical presentation has not been reported in the endoscopic or transplant literature.