[Extreme hyperbilirubinemia associated with spherocytosis and choledocholithiasis]

Spherocytosis conditions the severe destruction of red blood cells. The spleen plays an active and fundamental role in this destruction since it is responsible for the fragility and lability of the red blood cell to the splenic medium. The clinical manifestations are: anemia, jaundice, splenomegaly, and hemolytic and aplastic crisis associated to viral infections. Choledocholithiasis is a manifestation of the disease which can be seen at an early stage, even in less severe cases. Choledocholithiasis is rare and this may be due to immediate surgical intervention. The levels of indirect bilirubin may vary but usually do not exceed 10 mg%, on the rising of direct bilirubin may cause suspicion of liver obstruction or damage. A case of a ten year old boy is reported who was found to have spherocytosis, with severe manifestations, who later developed cholelithiasis and total obstruction of the choledocho and in who the most important clinical manifestation was jaundice due to the increase of total bilirubin to 89 mg%, doubly checked. Both a splenectomy and a cholecystectomy were performed. Subsequent checkups were normal. These levels of bilirubin have not been previously reported. Hyperbilirubinemia; spherocytosis; choledocholithiasis.