# A Rare Case of Biliary Cast Syndrome After Orthotopic Liver Transplantation

## TL;DR

This paper reports a rare case of biliary cast syndrome in a liver transplant patient, emphasizing the importance of early diagnosis and treatment.

## Contribution

The paper presents a rare clinical case of biliary cast syndrome following liver transplantation.

## Key findings

- A 48-year-old woman developed biliary cast syndrome nine weeks after liver transplantation.
- The patient experienced complications including biloma, anemia, and septic shock.
- Endoscopic removal of biliary casts was partially successful using a SpyBite basket.

## Abstract

Biliary cast syndrome (BCS) is a rare complication following orthotopic liver transplantation (OLT), characterized by the formation of casts within the biliary system. We present the case of a 48-year-old woman who developed BCS nine weeks post-transplant. The patient experienced multiple complications, including biloma formation, recurrent anemia, and septic shock. Endoscopic retrograde cholangiopancreatography (ERCP) revealed extensive biliary casts, which were partially removed using a SpyBite basket (Boston Scientific, Marlborough, MA, USA). This case highlights a rare but serious complication of liver transplantation. Early recognition and aggressive treatment are crucial for improving outcomes in liver transplant recipients with BCS.