This 54 year old gentleman underwent a living donor liver transplant (his son was the donor) in January (10 months ago) at our centre. Early post transplant MRCP films showed narrowing at the anastomotic site but since his Labs were normal, we decided to monitor him. His latest MRCP, done a month ago, showed the stricture (A: white arrow) and that, along with rising bilirubin levels, prompted us TO intervene. Contrast injection on ERCP outlined the pancreatic duct (B: white arrow) and the strictured anastomotic site (C & D: white arrows). Three ducts, the right anterior, right posterior and segment VIII ducts had been anastomosed to the native duct. We were able to pass a guidewire, followed by a dilatation catheter in the right posterior duct (E: white arrow). We the dilated the right posterior and segment VIII anastomoses with a TTS wire guided balloon (F & G, respectively: white arrows). We ended the procedure with a 12 cm 10 French plastic stent placement in the right posterior duct (H: white arrows).
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