2015 Volume 57 Issue 4 Pages 1177-1183
Biliary cast syndrome (BCS) is an infrequent complication of liver transplantation and few cases have been reported in the non-transplant population. A 59-year-old man, who had undergone a distal gastrectomy and cholecystectomy due to gastric cancer, presented with jaundice and fever. Magnetic resonance cholangiopancreatography demonstrated dilatation of intra- and extra-hepatic ducts. Endoscopic biliary drainage failed due to a Roux-en-Y reconstruction, and percutaneous transhepatic biliary drainage was subsequently performed. Biliary casts were histopathologically confirmed, and found to be composed of inflammatory submucosal tissue mixed with bilirubin and collagen. The pathogenesis of the biliary casts in this case is unknown; however, we speculate that cholangitis and liver ischemia associated with surgical intervention were predisposing factors. BCS after gastrectomy is a rare event, but should be considered as a possible postoperative complication in gastric cancer patients.
