Case on a patient with biliary strictures in one-half of the liver after liver transplantation

A 57-year-old male patient with end-stage liver disease because of nonalcoholic steatohepatitis-induced liver cirrhosis and three hepatocellular carcinomas smaller than 2 cm each was placed on the waiting list for liver transplantation. His medical history revealed no other abnormalities, apart from the liver disease. Physical examination showed a patient in good clinical condition with slight jaundice. He was depended on diuretic medication to control ascites. Severity of cirrhosis was considered Child-Pugh B and his Model for End-Stage Liver disease score was 17. CT scanning showed no signs of metastatic disease, and portal vein, hepatic artery, hepatic veins, and inferior vena cava were patent. A heart beating donor became available and the donation procedure was uneventful. The liver graft was reperfused after the side to side cavocavostomy and portal venous anastomosis were performed. On the first postoperative day, turbulent flow was noticed in several right portal vein branches during routine Doppler ultrasonography. After discharge, during the following months, the patient suffered from recurrent atacks of cholangitis.

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