Integrated treatment of secondary hepatolithiasis. Case report.
Hepatolithiasis is defined as the occurrence of stones proximal to the biliary confluence and represents a prevalent disease in South East Asia being uncommon in Western countries. Biliary sepsis, hepatic abscesses and cholangiocarcinoma are considered potential complications. The Authors describe a case of a 68 years male patient affected by a left massive intrahepatic lithiasis secondary to common duct stones and associated to acute pancreatitis. The patient refused surgery and was submitted to a conservative transhepatic percutaneous treatment. After a complete removal of intrahepatic stones and a positioning of external internal biliary drainage (14F), a laparoscopic cholecistectomy was performed. The MRI control showed a complete resolution of the intrahepatic lithiasis. Conservative transhepatic percutaneous approach to hepatolithiasis represents a safe and effective treatment allowing good medium-long term results. Surgery is recommended in case of severe hepatic fibrosis or atrophy, suspected cholangiocarcinoma or multiple strictures with biliary distorsion. Integrated therapeutical protocols in referral multidisciplinary centers-offers the best long term results.
Second University of Naples, Italy.
G
G
Conzo
F
F
Stanzione
S
S
Celsi
G
G
Candela
P
P
Venetucci
A
A
Palazzo
C
C
Della Pietra
L
L
Santini
V
V
Iaccarino
D000368:Aged; D006801:Humans; D020347:Lithiasis / Q000209:etiology / Q000601:surgery*; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery*; D008297:Male