A CASE OF PRIMARY INTRAHEPATIC PURE CHOLESTEROL STONES

Abstract

A 49-year-old man was admitted to our hospital with the chief complaints of epigastralgia and vomiting. Abdominal ultrasonography, abdominal Computed Tomography (CT) and percutaneous transhepatic cholangiography revealed intrahepatic stones localized in the anterior superior subsegment (S8) and common bile duct stones. Laparotomy was performed. After cholecystectomy and choledochotomy two stones in CBD could be taken out. Thereafter lithotripsy was carried out using cholangioscope (CHF-P10) and electrohydraulic lithotriptor (SD1) for stones in S8). No inflammatory findings nor stones were found in the gallbladder. Marked cholesterolosis was seen in the mucosal membrane of gallbladder. As a result of constituent analysis by infrared ray absorption spectrum, it was identified that all stones in intrahepatic and common bile duct contained pure cholesterol. We thought that two stones in CBD had dropped down from bile duct in S8 to CBD and so we diagnosed this case as pure cholesterol stones originated from intrahepatic bile ducts. Postoperative hepatobiliary scintigraphy and abdominal CT proved improvements in delayed bile flow and dilated bile duct localized in S8. This case appears very suggestive in discussing appropriate indication of hepatic resection for hepatolithiasis.