HEPATOLITHIASIS AND BILIARY PARASITES

Hepatolithiasis, or the presence of intrahepatic stones, is prevalent in East Asia and is characterized by the finding of stones within the intrahepatic bile ducts proximal to the confluence of the right and le ft hepatic ducts. Bile stasis and bacterial infection have been incrim inated as the major aetiopathogenic factors. Clinical features include recurrent pyogenic cholangitis, multiple liver abscesses, secondary b iliary cirrhosis and cholangiocarcinoma. The goals of management inclu de accurate localization of pathologies, control of biliary sepsis and the elimination of stones and stasis. Ultrasonography, computed tomog raphy and direct cholangiography complement each other in defining the stones, strictures and degree of liver damage. Non-operative biliary decompression by endoscopy and interventional radiology is effective i n controlling the infection, but surgery remains the mainstay for the treatment of stones and strictures. Intra-operative ultrasound and fle xible choledochoscopy, combined with percutaneous transhepatic cholang ioscopy and intraductal lithotripsy, facilitate stone removal. Balloon dilatation and biliary stenting serve to open the bile duct stricture s. The creation of a hepaticocutaneous jejunostomy after conventional surgery allows atraumatic access to the biliary system for the removal of recurrent stones. The management of biliary parasites begins with conservative measures, including analgesics and anti-helminthic therap y. In refractory cases or patients with acute cholangitis, endoscopic biliary drainage and the extraction of worms may be necessary. Improve ment in sanitation plays a crucial role in the epidemiological control of these biliary diseases.