Biliary Cast Syndrome in an Opium Inhaler

Dabiri, Reza; Aghdae, Hamid Asadzadeh; Rajabalinia, Hasan; Alizadeh, Amir Houshang Mohammad

doi:10.1159/000355165

Cited by 2 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 Another potential contributing factor is prolonged sedation, which may lead to the dilation of the bile duct and an increase in biliary pressure. 16,17 Therefore, we propose that biliary dyskinesia secondary to prolonged sedation is also a predisposing factor for BCS in our case. These factors lead to cholangiocyte necrosis, cast formation, recurrent infection, and abscess formation.…”

Section: Discussionmentioning

confidence: 71%

Intensive Care Unit–Related Cholangiopathy-Induced Biliary Cast Syndrome Without Liver Transplantation: A Rare Entity

Vikash,

et al. 2024

ACG Case Rep J

View full text Add to dashboard Cite

The development of biliary cast syndrome (BCS) is very rare, mostly documented in patients with liver transplantation. The etiology of BCS is unknown; however, risk factors include post–liver transplant bile duct injury, ischemia, infection, fasting, parenteral feeding, and increased bile viscosity and gallbladder dysmotility. We present the case of a 41-year-old man who developed BCS secondary to a prolonged intensive care unit course without a liver transplant. This case highlights the importance of monitoring patients with protracted intensive care unit course and abnormal aminotransferases to recognize and timely manage cholangiopathy and BCS-related complications.

show abstract

Section: Discussionmentioning

confidence: 71%

Intensive Care Unit–Related Cholangiopathy-Induced Biliary Cast Syndrome Without Liver Transplantation: A Rare Entity

Vikash,

et al. 2024

ACG Case Rep J

View full text Add to dashboard Cite

show abstract

“…Table 1 summarizes the different scenarios in which the biliary cast syndrome has been described [19][20][21][22][23][24][25][26]. Initial treatment of the syndrome should be endoscopic biliary sphincterotomy and cast extraction.…”

Section: Discussionmentioning

confidence: 99%

“…In cases where it is not possible to completely remove the casts, nasobiliary drainage placement has been proposed to clean up bile ducts [3]. Also, ursodeoxycholic acid has been used as complementary treatment in difficult or recurrent cases [22,23,26]. Surgical treatment should be reserved for those cases in which endoscopic manoeuvres have failed.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Biliary Cast Syndrome Post Hepatic Trauma

López-Rosés¹

2017

GHOA

View full text Add to dashboard Cite

Biliary cast syndrome is a rare disorder that is characterized by the presence of casts in the biliary ducts, causing obstruction leading to infection and hepatic and ductal damage. The syndrome is more commonly reported in liver transplant patients, being very unusual in other situations. We report a case in a patient that suffered a severe hepatic trauma that was successfully managed by endoscopic therapy. IntroductionThe biliary cast syndrome is a rare phenomenon that develops due to precipitation of amorphous material in the bile ducts, forming casts that lead to obstruction with consequent infection and damage to liver parenquima and duct. The syndrome has DiscussionThe formation of casts of the bile ducts (biliary cast syndrome) is caused by mechanisms not clearly understood, that involve factors such as ischemia, infection, hemolysis and liver surgery among others. These casts are made up primarily of calcium bilirrubinate, cholesterol crystals and mucus [5]. Recently, by using scanning electron microscopy and hematoxilin and eosin staining, studies showed that cast also contains blood vessels and collagen fibers [11,12]. From a theoretical standpoint, any situation that increases the viscosity of bile or decreases bile flow, may lead to the formation of casts. The vast majority of cases reported occurred in liver transplant patients, especially during the first few years of application of the technique, where graft preservation methods were less sophisticated than today. Some studies have linked the formation of the casts with the existence of faulty reconstructions of the biliary tract, which would cause injury to the biliary epithelium and trigger the precipitation of material in it. This in combination with infection and a cholesterol-saturated bile, play a role in the formation of casts after transplantation [7]. Moreover, the presence of ischemia is believed to be one of the main triggers of this syndrome, because it has been shown that the presence of casts after liver transplantation was accompanied by hepatic artery occlusion in 30% of cases [4]. Also, some drugs used post transplant, such as cyclosporine, may contribute to the emergence of casts, by inhibiting the secretion of bile, causing a functional bile stasis [8]. Furthermore, the presence of foreign bodies such as T tubes or prosthesis may act as a nidus for formation of stones or sludge [13]. Systemic bacterial or fungal infection, which causes intrahepatic cholestasis may also be a predisposing factor to the formation of casts in the bile ducts after liver transplantation [14]. Finally, many others have been associated as risk factors for the formation of biliary casts, such as, hepatic artery stenosis or thrombosis, biliary strictures, renal replacement therapy, ischemia-reperfusion injury, prolonged cold preservation, prolonged warm ischemia, hemolysis, pregnancy or AIDS virus infection [15][16][17][18].Casts can also occur in non-transplant patients, although that is extremely unusual; only a few cases have been published to...

show abstract

Biliary Cast Syndrome in an Opium Inhaler

Cited by 2 publications

References 16 publications

Intensive Care Unit–Related Cholangiopathy-Induced Biliary Cast Syndrome Without Liver Transplantation: A Rare Entity

Intensive Care Unit–Related Cholangiopathy-Induced Biliary Cast Syndrome Without Liver Transplantation: A Rare Entity

Endoscopic Management of Biliary Cast Syndrome Post Hepatic Trauma

Contact Info

Product

Resources

About