Traumatic neuroma with biliary duct obstruction after orthotopic liver transplantation

Background Traumatic neuromas may develop after injury to nerve fibers enca sed in Schwann cells. The incidence of symptomatic neural tumors appears to be low after orthotopic liver transplantation (OLT). Only two cases of bil iary stricture caused by infiltrating traumatic neuroma have been described previously. Methods. We report two new cases of biliary tract obstruction after OLT tha t failed to respond to percutaneous balloon dilatation and were corrected b y a resection of the bile duct stricture followed by biliary reconstruction with a Roux-en-Y jejunal loop. Results. The first patient (17 months after OLT) had a traumatic neuroma ap pearing as a distinct mass with nerve bundles confirmed histologically; the traumatic neuroma in the second patient (5 months after OLT) was a nerve s tump with infiltration of nervous elements in the bile duct. Both patients recovered without complications. Conclusions. Traumatic neuromas should be considered in the differential di agnosis of late biliary stricture after OLT, in particular when not respond ing to percutaneous dilatation or stenting.