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Hepatolithiasis: a case report and literature review
Hepatolithiasis (HL) is defined as calculi in the biliary ducts proximal to the joining of the right and left hepatic ducts regardless of the presence of concurrent gallstones in either the gallbladder or common bile duct. Most HL cases are asymptomatic. When patients do present with symptoms, they are usually features of cholangitis.
43 year old Bengali male presented to the emergency department with signs of cholangitis and a past surgical history of recurrent cholangitis and multiple endoscopic retrograde cholangeopancreatographies (ERCPs). He was febrile with scleral icterus and right upper quadrant abdominal tenderness with a positive Murphy’s sign. His labs showed and elevated white blood cell count, alkaline phosphatase, total bilirubin, and C-reactive protein. Computed tomography of the abdomen revealed multiple intrahepatic stones occluding the left hepatic biliary duct causing proximal dilation of the hepatic duct.
The patient was diagnosed with acute ascending cholangitis and a left hepatectomy was done. The post-operative period was uneventful.Hepatolithiasis is a rare disease found mostly in East Asia. The gold standard for its diagnosis is ERCP and PTC. The current options for treating HL include non-surgical endoscopic approaches and hepatectomy. Indications for its surgical management include presence of stones in one lobe (especially left-sided), multiple large stones that cannot be treated by other methods, complications secondary to cholangitis and suspicion of cholangiocarcinoma.
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