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[Intrahepatic lithiasis (considerations on 20 cases)].

I Juvara, S Gavrilescu, C Dragomirescu

    Revista De Chirurgie, Oncologie, Radiologie, O.R.L., Oftalmologie, Stomatologie. Chirurgie
    |May 1, 1981
    PubMed
    Summary
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    This study analyzed 20 intrahepatic lithiasis cases, finding causes ranging from metabolic issues to ascending obstruction from the common bile duct. Surgical intervention, primarily bilio-digestive anastomosis, was preferred, though challenges and a 20% mortality rate were noted.

    Area of Science:

    • Gastroenterology
    • Hepatobiliary Surgery

    Background:

    • Intrahepatic lithiasis, or stones within the liver, presents diagnostic and therapeutic challenges.
    • Understanding the diverse etiologies of intrahepatic stones is crucial for effective management.

    Observation:

    • Analysis of 20 cases revealed intrahepatic lithiasis arising from metabolic disturbances, congenital anomalies, post-surgical complications, or ascending obstruction/migration from the hepato-choledocus (common bile duct).
    • Intraoperative cholangiography proved essential for accurate diagnosis.
    • Bilio-digestive anastomosis, specifically hepatic duct-jejunal anastomosis on a "Y" loop, was the preferred surgical approach in 15 patients.

    Findings:

    • The study identified multiple origins for intrahepatic stones, with ascending obstruction/migration from the common bile duct being the most frequent (12 cases).

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  • Surgical management strategies were evaluated, with bilio-digestive anastomosis demonstrating satisfactory outcomes.
  • Factors complicating surgery included congenital intrahepatic septa and narrow common bile ducts.

    • Implications:

    • The findings underscore the importance of considering diverse etiologies for intrahepatic lithiasis.
    • Hepatic duct-jejunal anastomosis on a "Y" loop offers a viable surgical solution for complex cases.
    • A 20% mortality rate highlights the severity and potential complications, such as hepato-renal failure, associated with intrahepatic lithiasis.