Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis.
OBJECTIVE
To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.


METHODS
The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct (CBD) stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.


RESULTS
In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 (51.0%) had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 (41.2%) had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitis in the group undergoing urgent surgery (total 74 patients), the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin (1.14 +/- 1.27 mg/dL vs 2.66 +/- 1.97 mg/dL, P < 0.001) and white cell count (9480 +/- 4681/microL vs 12840 +/- 5273/microL, P = 0.018).


CONCLUSIONS
Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.
Chang
Chen-Wang
CW
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei 10449, Taiwan, China.
Chang
Wen-Hsiung
WH
Lin
Ching-Chung
CC
Chu
Cheng-Hsin
CH
Wang
Tsang-En
TE
Shih
Shou-Chuan
SC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002764:Cholecystitis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D042883:Choledocholithiasis / Q000473:pathology* / Q000503:physiopathology; D002769:Cholelithiasis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies