Obstructive putty-like cast of the biliary tree

Area of Science:

• Hepatobiliary Surgery
• Gastroenterology
• Medical Imaging

Background:

• A 62-year-old woman presented with cholangiosepsis and a history of liver metastases.
• She had undergone left hemihepatectomy and chemoradiation for liver recurrence, presenting with intrahepatic abscesses and biliary dilation.

Observation:

• Magnetic resonance imaging (MRI) revealed multiple intrahepatic fluid collections/abscesses and dilated bile ducts.
• Rising serum bilirubin indicated significant hepatic function impairment, necessitating antibiotic treatment and percutaneous drainage.

Findings:

• Surgical exploration via hepatotomy revealed a putty-like material, which was removed as a large cast of the biliary tree.
• The differential diagnosis included tumor recurrence or post-radiation fibrosis causing biliary obstruction.

Implications:

• This case highlights an unusual cause of biliary obstruction and cholangiosepsis.
• Successful surgical intervention involved hepatotomy and jejunal loop creation for improved biliary drainage.
• The removal of a large biliary cast offers insights into complex hepatobiliary pathology.