Intrahepatic stones

Abstract

The location, consistency, number and behavior of intrahepatic biliary duct stones are entirely different from choledocholithiasis of gallbladder origin. The history of intrahepatic stones belongs to the 16th and 17th centuries and until 1936, 57 cases were collected from the World literature. The incidence of intrahepatic stones in the western countries, in contrast to southeast Asia, is very low. Two cases are described. Both were treated surgically and one died postoperatively; autopsy showed a biliary cirrhosis. Digby (1930), first described the clinical syndrome of intrahepatic stones. Men and women seem to be equally affected, and 86% are between 21-50 yr old. Most of the patients are undernourished. Clinical manifestations are those of cholangitis with 3 features of Charcot's triad of fever, right upper abdominal pain and jaundice. In its severest form the patient may have symptoms of shock, collapse, and toxemia. In such cases death would be imminent unless operation could be performed before the condition become too advanced. The interval between the attacks varies from once a week to 30 yr. Since almost all the intrahepatic stones are radiolucent, plain x ray film of the abdomen is not helpful. The most helpful diagnostic procedure is percutaneous transhepatic cholangiography. Surgical procedures include transhepatic lithotomy, hepatic lobectomy, sphincterostomy, and choledochoduodenostomy plus transhepatic lithotomy.