Biliary restoration using a combined endoscopic-percutaneous approach following 'orphan duct syndrome' after pediatric liver transplantation

A 2-year-old male with arginosuccinate lyase deficiency underwent left lateral segment liver transplantation complicated by “orphan duct syndrome (Celik et al., 2019) [1]” and biliary leak. After revision of the Roux-en-Y anastomosis, biliary drainage was still impaired. The excluded bile duct was diagnosed and a biliary restoration (or neo-duct) using a combined endoscopic and percutaneous approach was created by Gastroenterology and Interventional Radiology. To our knowledge, this case report represents the first combined endoscopic-percutaneous biliary restoration procedure performed in a pediatric patient.