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

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.