Intrahepatic Bile Duct Stone (Hepatolithiasis)

  •          Causes:
  • – Bile duct stricture
  • – Bile duct injury
  • – Primary/ secondary sclerosing cholangitis
  • – Recurrent pyogenic cholangitis (RPC)
  • – Choledochal cyst

 

  •             Complications of hepatolithiasis:
  •               – Acute: Cholangitis
  •               – Chronic:
  •                             • Secondary biliary cirrhosis
  •                             Segmental/ lobar atrophy
  •                             • Liver abscess
  •                             • Cholangiocarcinoma
  •            Investigations
  •                 – USG
  •                 – MRCP
  •            Treatment of asymptomatic hepatolithiasis
  •            – Treatment is not always necessary
  •            – Treatment in individualized
  •            – Wait and see approach
  •                Treatment of  symptomatic hepatolithiasis
  •          – Interdisciplinary team plan is useful
  •         – Primary importance: ERCP, Percutaneous transhepatic cholangiography
  •                       Surgical Resection:
  • – For unilateral stone disease, particularly if
  •                     • Biliary stricture
  •                     •Lobar atrophy present
  • **Partial hepatectomy is associated with high stone clearance (>80%) and fewer recurrence than endoscopic modalities

 

  •          Treatment of diffusely distributed intrahepatic bile duct stone:
  • – POCSL: Per Oral Cholangioscopic Lithotripsy
  • – PTCSL: Percutaneous Transhepatic Cholangioscopic Lithotripsy

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