Intrahepatic lithiasis: A western experience

Intrahepatic lithiasis (IHL) is a very rare disease in Europe and no gold-s tandard treatment has yet been codified. The aim of our study is to report our personal experience of IHL detected in 20 patients (6 males [30%] and 1 4 females [70%]) between January 1982 and December 1991. Eleven (55%) of th ese cases presented with only IHL, 7 cases (35%) had IHL associated with ga llbladder or common bile duct stones, while 2 (10%) were affected by second ary IHL caused by previous biliodigestive anastomosis-induced stricture. Th e diagnosis was determined by cholangiography in all patients, by ultrasoun d in 94.7%, and by computed tomography in 70%, The surgical procedures used were as follows: liver resection in 12 patients (60%); various types of bi liodigestive anastomosis in 6 cases (30%); choledocholithotomy with a simul taneous removal of stones from the hepatic duct in 2 patients (10%). The in traoperative mortality rate was nil, Complications consisted of 2 subphreni c abscesses, I septicemia, and 1 bowel occlusion, Two patients (10%) droppe d out of the follow-up, 2 (10%) died 2 Sears after surgery for reasons not connected with the disease, 1 (5%) died from suppurative cholangitis 6 mont hs after surgery, 2 (10%) had recurrent stones and were treated by extracor poreal lithotripsy and endoscopic stone removal, while the remaining 13 pat ients (65%) are symptom-free at follow-up which varied between 6 months and 11 years, Liver resection is the treatment of choice when IHL is confined to one lobe of the liver. When IHL affects the entire liver, a resection of the main involved area should be performed whenever possible. Other option s include hepatoduodenal anastomosis using the interposed jejunal loop to e nable endoscopic or combined treatment of recurrent stones.