POSITIONAL BILIARY OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Biliary complications are an important cause of morbidity following or thotopic liver transplantation (OLT). A 52-year-old woman had an OLT w ith duct-to-duct repair for non-A, non-B, non-C viral hepatitis. Three weeks postoperatively she developed positional obstruction of a redun dant ''S''-shaped bile duct. A supine cholangiogram failed to reveal t he obstruction, which only became evident when she was in the upright position. The bile duct was successfully ''straightened'' with an endo scopically placed stent; the obstruction resolved after removal of the stent 6 weeks later. Positional biliary obstruction should be suspect ed when bile duct obstruction occurs in the absence of fixed stricture s or other causes of obstruction such as dysfunction of the sphincter of Oddi.