A CASE OF INTRAHEPATIC STONES WHICH SHOWED DELAY OF BILE EXCRETION IN HEPATOBILIARY SCINTIGRAPHY AFTER LITHOTRIPSY

Abstract

We report a case of intrahepatic stones with severe delay of bile excretion in which there were no signs of recurring stones at three years and two months after biliary diversion. The patient was a 50-year-old man. There was a history of undergoing cholecystectomy, choledochotomy and papillosphincteroplasty for stones in the choledochus and gallbladder in August 1983. Recurred intrahepatic stones were found in October 1988. Hepatobiliary scintigraphy following percutaneous transhepatic cholangioscopic lithotripsy revealed a marked delay of bile excretion. Based on this finding, a diagnosis was reached of intrahepatic stones caused by reflux of digestive remnants and pancreatic juice. Choledochojejunostomy was performed in February 1989. Hepatobiliary scintigraphy performed in April 1992 showed that greatly delayed bile excretion still continued, but no recurred stones were found. The results in this case indicate that papillosphincteroplasty is not an appropriate means of surgical reconstruction for cases of intrahepatic stones with marked bile retention, and that biliary diversion rather should be the treatment of choice. It is also found that hepatobiliary scintigraphy is useful for determining the course of postoperative treatment in such cases.