Abstract

Introduction: Selected cases of complete common bile duct transection can be successfully treated using a combined endoscopic/transhepatic approach. Intrahepatic segmental exclusions are more challenging and such combined approach for repermeabilization has not been reported so far.
Case presentation: A 44-year-old woman with a past history of liver transplantation and ischemic cholangitis presented a hilar stricture involving both sides with a passable stricture on the left side (Amsterdam type C) and a complete blockage on the right side, excluding segments V and VIII (Amsterdam type D). We present here the management of these lesions: first was managed endoscopically and the second by percutaneous/endoscopic rendez-vous technique.
Conclusion: Intrahepatic biliary reconnection is feasible, but more difficult than common bile duct reconnection and benefits from using multiple guidance modalities.

Keywords:Liver transplantation; Biliary stricture; Segmental biliary disconnection; Rendez-vous technique