Gun-Sight Technique With Dual Hepatic Vascular Embolization for Sigmoidal Refractory Biliary Stricture After Living-Donor Liver Transplantation: A Case Report

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-01 DOI:10.1016/j.transproceed.2024.10.041

Yuta Yamada, Kenei Furukawa, Koichiro Haruki, Shinji Onda, Yoshihiro Shirai, Masashi Tsunematsu, Mitsuru Yanagaki, Michinori Matsumoto, Yosuke Igarashi, Toru Ikegami

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引用次数: 0

Abstract

Background

Biliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE).

Case presentation

A 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe. Duct-to-duct biliary anastomosis was performed, and V5 and V8 of the graft were reconstructed using a vein graft. However, 5 months after surgery, magnetic resonance cholangiopancreatography revealed stricture of the bile duct anastomosis. Endoscopic stenting could not be attempted because of the sigmoidal bending of the bile duct. Instead, percutaneous transhepatic cholangiographic drainage (PTCD) of the anterior and posterior branches was performed. We attempted to remove the PTCD tube by an endofistulization technique. We performed the gun-sight technique, originally employed for transjugular intrahepatic portosystemic shunt procedures, to create a pathway for internal drainage of the posterior segment. The anterior lobe was abandoned by applying DHVE, resulting in no external drainage tubes.

Conclusion

Application of the gun-sight technique with DHVE for sigmoidal refractory biliary stricture after LDLT appears to be a feasible treatment.

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枪瞄技术联合双肝血管栓塞治疗活体肝移植后乙状结肠难治性胆道狭窄1例。

背景：胆道狭窄是活体肝移植（LDLT）术后常见的并发症，但其治疗具有挑战性。我们在此报告一例成功的内引流通过枪瞄准技术和双肝血管栓塞（DHVE）的结合。病例介绍：一名54岁的原发性胆管炎女性接受了abo血型不相容的右肝叶LDLT。行胆管-胆管吻合，用静脉移植重建V5和V8。然而，术后5个月，磁共振胆管造影显示胆管吻合口狭窄。由于胆管乙状体弯曲，内镜下支架置入不能尝试。相反，经皮经肝胆管造影引流（PTCD）的前和后支进行。我们试图通过内瘘技术取出PTCD管。我们采用枪瞄准技术，最初用于经颈静脉肝内门静脉系统分流术，为后段的内引流创造通道。应用DHVE放弃前叶，导致无外引流管。结论：应用瞄准镜技术联合DHVE治疗LDLT术后乙状结肠顽固性胆道狭窄是可行的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.