Published online Dec 24, 2017. doi: 10.5500/wjt.v7.i6.359
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
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.
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.
Biloma, anastomotic bile leak, pancreatic cyst, pancreatic pseudo cysts, and cystic duct mucocele after transplantation.
Liver function test revealed elevated canallicullar enzymes, complete blood count showed elevated white blood cells, and blood cultures were unremarkable.
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).
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.
See the reference list: Ref. [2,4,7].
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.
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.