title: Natural progression of untreated hepatolithiasis that shows no clinical signs at its initial presentation.
abstract: OBJECTIVE
  To elucidate the natural progression of hepatolithiasis that showed no signs at the time of initial presentation.
  
  
  METHODS
  Over a 17-year period, we observed 122 of 311 patients with hepatolithiasis who reported no symptoms and, thus, who received no treatment at initial presentation. The follow-up period was for up to 15 years (mean, 10.08 years).
  
  
  RESULTS
  Fourteen of 112 patients (11.5%) developed some symptoms attributed to hepatolithiasis. The interval until the onset of symptoms ranged from 9 months to 7.33 years (mean, 3.42 years ). The developing symptoms included abdominal pain, hepatic abscess, cholangitis, and cholangiocarcinoma. Nine of the 14 patients (64.3%) developed stone migration to the extrahepatic bile duct at the onset of clinical symptoms. The incidence of lobar liver atrophy on computed tomography in the patients with symptomatic hepatolithiasis (13 of 14 patients; 92.9%) was significantly higher than that in the patients with asymptomatic hepatolithiasis (14 of 108 patients; 13.0%). The prognosis of the patients with symptomatic hepatolithiasis were as follows: 2 died of cholangiocarcinoma, 1 died of hepatic failure, and 11 survived. Fifteen of asymptomatic patients died, but none of these deaths were attributed to hepatolithiasis.
  
  
  CONCLUSIONS
  Close observation is an alternative management at initial presentation for patients with asymptomatic hepatolithiasis without extrahepatic stones or lobar liver atrophy.
authors.affiliation: First Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. t-kusano@med.u-ryuku.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kusano
authors.forename: T
authors.initials: T
authors.lastname: Isa
authors.forename: M
authors.initials: M
authors.lastname: Ohtsubo
authors.forename: T
authors.initials: T
authors.lastname: Yasaka
authors.forename: M
authors.initials: M
authors.lastname: Furukawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002423:Cause of Death; D002648:Child; D002769:Cholelithiasis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019370:Observation; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed