Percutaneous transhepatic bilio-enteric neoanastomosis via the transseptal puncture system in a child with split liver transplant and severe occluded hepatico-jejunostomy

Pediatric split liver transplantation can be frequently complicated with stenosis of the hepatico-jejunostomy, a high-morbidity outcome that might progress to secondary biliary cirrhosis and require re-transplantation if left untreated. Percutaneous interventional radiology management is typically the safest and most efficient way to prevent surgical revision of the stenotic bilio-enteric anastomosis because the endoscopy is typically not viable in the Roux-en-Y. We report the case of a 6-year-old child with a left lateral segment partial liver transplantation and acute onset of cholestasis due to occlusion of the hepatico-jejuno anastomosis. The biliary stricture was non-crossable with conventional interventional radiological techniques, so the transseptal puncture system was successfully used to resolve the stenosis, creating a new bilio-digestive communication via the percutaneous transhepatic approach. Employment of the transseptal puncture system for percutaneous transhepatic biliary interventional procedures is unusual because this device is commonly used by interventional cardiologists to carry out treatments that necessitate direct access to the left atrium via interatrial septal puncture. Percutaneous transhepatic recanalization of high occlusive biliary stricture is a rare but feasible and valuable procedure alternative to the surgical resolution. Despite the small number of cases reported in literature, it must be regarded as a backup therapy option in the event that the traditional methods are ineffective.