Retained surgical stents as a cause of biliary obstruction in pediatric liver transplants

Abstract

Surgical stents in children undergoing hepaticojejunostomy may be retained and cause biliary obstruction. Radiologists involved with imaging these patients should be aware of this potential cause of biliary obstruction. This complication is amenable to interventional radiology techniques with good long-term results. There is no easy endoscopic or surgical treatment option in these patients.

Percutaneous Transhepatic Treatment for Obstructing Retained Surgical Biliary Stents After Pediatric Liver Transplantation Without Placement of Biliary Drain

“…Typically, the plastic stents pass into the small bowel from the biliary tree and are excreted ( 1 ). If they do not advance normally, sludge may encrust these retained stents leading to biliary obstruction, necessitating their removal ( 4 ).…”

“…Crowley et al ( 4 ) detailed 3 cases in which pediatric liver transplant recipients presented with retained biliary stents causing obstruction. All 3 of these patients underwent stent retrieval in which the snare technique was used to remove the stent through a 7 Fr sheath and all patients required internal–external biliary drain placement ( 4 ).…”

“…The standard of care for managing biliary obstruction includes minimally invasive treatment with interventional radiology placement of internal–external biliary drain and cholangioplasty or surgical revision of the bilioenteric anastomosis. Typically, during percutaneous biliary stent retrieval, a transhepatic sheath is placed followed by an internal–external biliary drain to aid with treatment of the biliary obstruction over several weeks to months ( 4 ). We present a case detailing a novel technique of biliary stent removal without requiring subsequent biliary drain placement.…”

Intrahepatic migration of pancreatic stent after pancreaticoduodenectomy: percutaneous cholangioscopic retrieval is feasible

“…Techniques such as IR-assisted percutaneous snaring, endoscopic retrograde cholangiopancreatography (ERCP), ERCP with SpyGlass (Boston Scientific) or balloon-assisted enteroscopy have been described for retrieving retained biliary foreign bodies, however, these techniques can be challenging. [7][8][9] IR-assisted percutaneous cholangioscopy using choledochoscopes to manage biliary stones is well described. 10 11 This technique is also used at our institution to manage complex intrahepatic biliary stones.…”