title: Treatment of intrahepatic calculi in Caroli's disease by non-invasive saline washout.
abstract: The case of a 59 year old pluriparous woman who underwent cholecystectomy and exploration of the main biliary pathway for cholecystic and common bile duct stones is described. Postoperative T-tube cholangiography showed a voluminous saccular dilatation stacked with calculi located on the left main hepatic duct. The patient was immediately transferred to our Centre, and a T-tube was used to introduce a guidewire/M 0.035 (Terumo, Tokyo, Japan) at the bottom of the cystic dilatation. A 6.0F drainage catheter (Angiomed, Germany) was placed over the subsequently withdrawn guidewire and a 60-minute saline washout was administered (625 ml). Subsequent cholangiography showed the total clearance of the cyst; papillotomy and a second saline washout led to some of the larger stones, which had remained in a prepapillary location, being made to flow easily into the duodenum. Discharged five days after admission, the patient is well one year later and has not experienced any further disturbance; an ERCP has shown the persistence of the biliary clearance. When the circumstances allow it, this noninvasive treatment of intrahepatic calculi is proposed before undertaking any surgical or invasive procedure.
authors.affiliation: University of Milan School of Medicine, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tritapepe
mesh_terms: D016767:Caroli Disease / Q000150:complications*; D002767:Cholecystostomy / Q000379:methods; D002769:Cholelithiasis / Q000628:therapy*; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D008875:Middle Aged; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D012965:Sodium Chloride