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Cystic duct remnant mucocele in a liver transplant recipient
Sushil K Ahlawat1, Thomas M Fishbien, Nadim G Haddad
1Department of Medicine, Division of Gastroenterology, Georgetown University Hospital, Washington, DC, USA. sushilka@aol.com
Insights
Cystic duct remnant mucocele, a rare liver transplant complication in children, can cause biliary obstruction. In this case, it resolved spontaneously after cholangiography, avoiding surgery.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Cystic duct remnant mucocele is an exceptionally rare complication following pediatric liver transplantation.
- Biliary obstruction due to mucocele typically necessitates surgical intervention.
Observation:
- A 14-month-old child, post-liver transplant for hepatoblastoma, developed biliary obstruction.
- Imaging revealed a mucocele of the allograft cystic duct remnant.
Findings:
- The mucocele and associated biliary obstruction resolved spontaneously on follow-up imaging.
- Resolution was likely attributed to guidewire manipulation during cholangiography, facilitating drainage.
Implications:
- This case suggests that conservative management may be an option for cystic duct remnant mucoceles in select pediatric liver transplant patients.
- Non-surgical resolution highlights the potential for spontaneous decompression and the importance of careful imaging follow-up.
Abstract:
Cystic duct remnant mucocele is an extremely rare complication of liver transplantation in children. Surgical correction is usually required for cystic duct remnant mucocele when it causes biliary obstruction. We describe a 14-month-old liver transplant recipient who presented with biliary obstruction 1 month after orthotopic liver transplantation with an end-to-end choledochocholedocal biliary anastomosis for hepatoblastoma. US, CT and cholangiography findings were consistent with mucocele of the allograft cystic duct remnant. Surgery was not needed in our patient because the mucocele and biliary obstruction had resolved on repeat imaging most likely due to guidewire manipulation during cholangiography, resulting in opening of the cystic duct remnant orifice and drainage into the common duct.