Abstract
From 1980 through 1988, biliary surgery was performed in 197 patients with acute gallstone disease and concomitant elevation of serum glutamic oxalacetic transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT) of over 300 Karmen units. In 137 patients, anatomic inspection and liver biopsy were performed during the acute stage of the disease. Impacted and floating bile duct stones were found in 69 (50%) and in 43 (32%) of the 137 patients, respectively. The main liver histology was necrosis of liver cells. After surgery, high serum transaminase fell rapidly with immediate recovery in 99% of the patients. In the remaining 60 patients, their signs and symptoms settled soon after initial conservative treatment and surgery was performed after an average time of 21 days. At laparotomy, impacted bile duct stones were found in 2 (3%) and liver histology revealed regeneration of liver cells. These findings suggest that marked elevation of serum transaminase in patients with acute gallstone disease might be due to an acute inflammatory liver cell injury caused by impacted bile duct stones or migrating stones, which would be transient and reversible after early resolution of the bile duct obstruction.
Highlights
The management of patients with gallstones, especially with bile duct stones, has been facilitated by the measurement of serum alkaline phosphatase or bilirubin.High levels of serum glutamic oxalacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), on the other hand, are considered strongly indicative of hepatocellular damage and are usually reliable in the differentiation of hepatocellular from extrahepatic biliary tract diseases
In one of the 25 patients who had stones in the gallbladder only, the intraoperative cholangioscopy demonstrated ampullary injury. This finding was thought to be a residual sign of previous ampullary obstruction by a stone which might have migrated into the duodenum because a gallstone identical to those in the gallbladder was recovered from her feces after operation
Biliary surgery consisted of cholecystectomy and operative cholangiography, with choledocholithotomy followed by T-tube decompression of the common bile duct or drainage procedures such as papilloplasty or choledochoduodenostomy if common bile duct stones were present
Summary
The management of patients with gallstones, especially with bile duct stones, has been facilitated by the measurement of serum alkaline phosphatase or bilirubin. High levels of serum glutamic oxalacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), on the other hand, are considered strongly indicative of hepatocellular damage and are usually reliable in the differentiation of hepatocellular from extrahepatic biliary tract diseases. Marked elevation of serum transaminase has been reported in patients with acute gallstone diseases such as acute cholecystitis1’2, choledocholithiasis and gallstone pancreatitis7’8. Its mechanism is not yet well understood and there have been controversial interpretations of such phenomena. Without adequate knowledge of the mechanism for such phenomena, high enzyme levels alone might lead to the diagnosis of so called hepatitis and delay in surgical intervention for fear of severe hepatic disease.
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