Case report: Complete cast formation of the entire intrahepatic biliary tree

Area of Science:

• Hepatobiliary surgery
• Transplantation medicine
• Gastroenterology

Background:

• Biliary complications, especially non-anastomotic strictures (NASs), present significant challenges in liver transplantation (LT).
• Bile cast syndrome (BCS) is a severe form of ischemic-type biliary complication following LT.
• Existing literature has limited data on the formation of complete hepatic casts in BCS.

Observation:

• This case report describes a unique instance of a complete hepatic bile cast.
• The complication occurred in a patient undergoing a second liver transplantation.
• The diagnostic and therapeutic journey for this rare presentation was documented.

Findings:

• The formation of a complete hepatic bile cast in BCS is a rare but severe complication.
• Detailed anatomical and pathological features of this specific BCS presentation were observed.
• The case highlights the complexities in diagnosing and managing such severe biliary issues post-LT.

Implications:

• This case enhances the understanding of Bile Cast Syndrome (BCS) and its severe manifestations.
• It provides valuable insights for clinicians managing liver transplant recipients with biliary complications.
• Further research into the pathogenesis and treatment strategies for complete hepatic casts in BCS is warranted.