Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2017; 7(6): 359-363
Published online Dec 24, 2017. doi: 10.5500/wjt.v7.i6.359
Mucocele mimicking a gallbladder in a transplanted liver: A case report and review of the literature
Thomas Chaly, Jeffrey Campsen, Ryan O’Hara, Rulon Hardman, Juan F Gallegos-Orozco, Heather Thiesset, Robin D Kim
Thomas Chaly, Jeffrey Campsen, Robin D Kim, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, United States
Ryan O’Hara, Rulon Hardman, Division of Radiology, University of Utah, School of Medicine, Salt Lake City, UT 84132, United States
Juan F Gallegos-Orozco, Division of Hepatology, University of Utah, School of Medicine, Salt Lake City, UT 84132, United States
Heather Thiesset, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, United States
Author contributions: All authors listed have contributed to this manuscript as described by the criteria in the authorship guidelines of the International Committee of Medical Journal Editors (ICJME).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Thomas Chaly, MD, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, School of Medicine, 30 N. 1900 E. 3B110, Salt Lake City, UT 84132, United States.
Telephone: +1-801-5852708
Received: July 15, 2017
Peer-review started: July 20, 2017
First decision: September 5, 2017
Revised: November 30, 2017
Accepted: December 5, 2017
Article in press: December 6, 2017
Published online: December 24, 2017
Case characteristics

A 48-year-old male who presented with right upper quadrant pain and was found to have a recipient cystic duct mucocele 3 mo after receiving a deceased donor liver transplant.

Clinical diagnosis

A diagnosis of cystic duct remnant mucocele was made given its appearance and recurrence, and ablation with sclerosing agents (ETOH) was attempted by interventional radiology on three separate occasions but was of little benefit.

Differential diagnosis

Biloma, anastomotic bile leak, pancreatic cyst, pancreatic pseudo cysts, and cystic duct mucocele after transplantation.

Laboratory diagnosis

Liver function test revealed elevated canallicullar enzymes, complete blood count showed elevated white blood cells, and blood cultures were unremarkable.

Imaging diagnosis

Abdominal X-ray (nonspecific), abdominal CT (mass or fluid collection at porta hepatis), abdominal MRI (mass or fluid collection at porta hepatis), MRCP (showed filling of the fluid collection ), and ERCP (showed filling of the fluid collection).

Pathological diagnosis

Resection and histologic analysis of the fluid filled mucocele revealed chronic cholangitis with prominent fibrosis, granulation tissue formation through mucosa, muscularis, and adventitia.


Surgical resection of the mass, and perioperative antibiotics.

Related reports

See the reference list: Ref. [2,4,7].

Term explanation

Mucocele: A swelling like a sac that is due to distension of a hollow organ or cavity with mucus; MRCP: Magnetic resonance cholangiopancreatography: A special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct; ERCP: Endoscopic retrograde cholangiopancreatography: A technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems; Gamma-glutamyltransferase: A transferase (a type of enzyme) that catalyzes the transfer of gamma-glutamyl functional groups from molecules such as glutathione to an acceptor that may be an amino acid, a peptide or water (forming glutamate); Mirizzi’s Syndrome: A rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct or common hepatic duct, resulting in obstruction and jaundice; Hepaticojejunostomy: Biliary-enteric anastomosis is usually to smaller ducts, which can be multiple if the injury or stricture is above the bifurcation of the right and left ducts.

Experiences and lessons

Cystic duct mucoceles after transplantation require a high index of suspicion requiring h and p, lab tests (liver function test, complete blood count, blood cultures), and imaging studies (abdominal X-ray, abdominal CT, abdominal MRI, ERCP) with resolution through surgical resection.