# Huge extrahepatic gallstone on percutaneous transhepatic biliary drainage tip—a pediatric case report

## TL;DR

A 5-year-old girl developed a rare gallstone on a drainage tip after liver transplant, successfully treated with a specialized procedure.

## Contribution

Reports a rare case of extrahepatic gallstone formation associated with biliary drainage in pediatric liver transplant patients.

## Key findings

- A gallstone formed on the tip of a biliary drainage catheter in a pediatric liver transplant patient.
- The complication was resolved using percutaneous transhepatic lithotripsy.
- The case highlights the need to consider drainage-tip stones when resistance is encountered during removal.

## Abstract

Biliary strictures, which are common in the first year after pediatric liver transplantation, are diagnosed and managed with percutaneous transhepatic cholangiography. In children undergoing percutaneous transhepatic cholangiography, early cholangitis is the most common complication while typical catheter-related complications are obstruction, dislodgement, kinking, or fracture. This case report discusses the unique presentation and management of a 5-year-old girl with an incidental percutaneous transhepatic biliary drainage-associated extrahepatic gallstone formation following treatment of biliary stricture after pediatric liver transplantation. It was effectively treated with percutaneous transhepatic lithotripsy. Although this is a rare but potentially harmful complication, in case of resistance at drainage removal, a drainage-tip stone should be excluded by ultrasound or fluoroscopy.

The online version contains supplementary material available at 10.1007/s00247-024-06156-4.