No abstract

Introduction: One of the etiologies of obstructive jaundice, is biliary stricture. Biliary stricture can present as either due to a benign or malignant cause. Traumatic neuroma rarely presents as a cause of obstructive jaundice, and is seen in literature usually following cholecystectomy or liver transplant. Methods: We present a case of a 30-year old woman, who presented with acute cholangitis 7 years after an elective laparoscopic cholecystectomy. Results: As this patient presented with cholangitis post surgery, she was stented and eventually underwent biliary reconstruction. The histopathology of the resected duct revealed a traumatic neuroma. In this case report, we review literature of traumatic neuroma presentation and its management. Conclusion: Traumatic neuroma of the bile duct can present with symptoms of biliary stricture. Although it is rare, it should be considered as a cause of benign biliary stricture.

under biliary surgery and the risk factors leading to bacterobilia. Methods: Retrospective study from 2014 to 2019. Surgeries involving biliary tree were included. Prior biliary procedures and personal risk factors were analyzed. Univariate analysis using Student t test, Fisher and chi2; relative risk was measured and multivariate logistic regression was performed. Statistical significance level set at 0,05. Results: Out of 86 biliary surgeries bacterobilia was documented in 45; 40 had some kind of biliary procedure prior final surgery (p=0,001), with a relative risk of 5,66 (CI 95% 1,8-17,3). When type of procedure was analyzed, percutaneous drainage showed no difference but ERCP had higher rate of bacterobilia (RR 3,14, CI95% 1,29-7,58). When previous cholangitis was developed bacterobilia was also higher (RR 2,53, CI 95% 1,04-6,1); but when patients were operated while receiving antibiotic treatment the rate of bacterobilia was lower (p=0,05). Age, sex, BMI, alcoholism, smoking, diabetes, inmunosupressive treatment, level of bilirubin, hemoglobin or albumin showed no difference. The presence of bacterobilia was not associated to higher rates of wound infection or other postoperative complications. In multivariate analysis only being operated under antibiotic treatment showed statistical significance (p= 0,041). Conclusion: Instrumentation of the biliary tree prior surgery should be performed in selective patients. Surgery during antibiotic treatment is feasible and reduces the risk of bacterobilia.

Results: LT was advised in 450(90%) patients. 45(9%) patients were lost to follow up. Predominant etiology was alcohol in 240/500(48%) and median MELD score was 24 . 54 out of 450(12%) eventually underwent LT. Of the 43 patients transplanted at our center there was no inpatient mortality. 231/450(51.3%)patients did not agree for evaluation. Finance was the reason 88/ 450(19.5%), unavailable donor in 57/450(12.7%), lack of both finance and donor in 68/450(15.1%), patient or family refusal in 18/450(4%), and preferring a different hospital for transplant in 11/450(2.4%). 77/396(19.4%) patients who did not undergo LT for various reasons died. 30/ 450(6.6%) patients improved on follow up and did not require LT. Conclusions: Lack of finances and living/deceased donors are the major impediments in LT. Improvement in organ allocation and deceased donation, public awareness, wider insurance coverage and financial support from government agencies can help in reducing mortality in patients eligible for LT.