VOLUME 32 - NUMBER 10 - 2011

Integrated treatment of secondary hepatolithiasis. Case repor

  • Conzo G., Stanzione F., Celsi S., Candela G., Venetucci P., Palazzo A., Della Pietra C., Santini L., Iaccarino V.
  • Clinical practice, 424-428
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  • Hepatolithiasis is defined as the occurrence of stones proximal to the biliary confluence and represents a prevalent disease in South East Asia being uncommon in Western contries. Biliary sepsis, hepatic abscesses and cholangiocarcinoma are considered potential complications. The Authors describe a case of a 68 years male patient affected by a left massive intrahepatic lithiasis secondary to common duct stones and associated to acute pancreatitis. The patient refused surgery and was submitted to a conservative transhepatic percutaneous treatment. After a complete removal of intrahepatic stones and a positioning of external internal biliary drainage (14F), a laparoscopic cholecistectomy was performed. The MRI control showed a complete resolution of the intrahepatic lithiasis. Conservative transhepatic percutaneous approach to hepatolithiasis represents a safe and effective treatment allowing good medium-long term results. Surgery is reccomended in case of severe hepatic fibrosis or atrophy, suspected cholangiocarcinoma or multiple strictures with biliary distorsion. Integrated therapeutical protocols in referral multidisciplinary centers-offers the best long term results.

  • KEY WORDS: Hepatolithiasis - Hepatic resection - Percutaneous cholangioscopic lithotomy.