title: Pathogenesis and Management of Hepatolithiasis: A Report of Two Cases.
abstract: Hepatolithiasis or primary intrahepatic stones are prevalent in the Far-East countries such as Korea, Japan and Taiwan. It has been associated with helminthiasis, bacterial infections, environmental and dietary factors. Despite high prevalence of helminthiasis like ascariasis, poor environmental condition and low protein diet, India and Middle-East countries have a low incidence of hepatolithiasis. We report two cases of hepatolithiasis associated with bacterial infections and were surgically managed. The first case is a 45-year-old female presenting with upper abdominal pain and fever. She had multiple calculi in intrahepatic biliary radicles, common bile duct, common hepatic duct and gall bladder. She was managed by cholecystectomy, left lateral liver sectionectomy, choledochoscopy assisted stone clearance of the residual liver and Roux-en-Y hepatico-jejunostomy. The second case is a 60-year-old female presenting with epigastric pain and fever and past history of cholecystectomy for cholelithiasis. She had multiple right and left intrahepatic calculi and managed by left lateral liver sectionectomy with excision of CBD and Roux-en-Y hepatico-jejunostomy. Both the cases showed growth of bacteria in the culture of the intraoperatively collected bile.
authors.affiliation: Senior Resident, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
authors.forename: Biswajit
authors.initials: B
authors.lastname: Dey
authors.affiliation: Senior Resident, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
authors.forename: Gourav
authors.initials: G
authors.lastname: Kaushal
authors.affiliation: Associate Professor, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
authors.forename: Sajini Elizabeth
authors.initials: SE
authors.lastname: Jacob
authors.affiliation: Assistant Professor, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
authors.forename: Adarsh
authors.initials: A
authors.lastname: Barwad
authors.affiliation: Professor, Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
authors.forename: Biju
authors.initials: B
authors.lastname: Pottakkat
keywords: Bacteria; Bile; Surgery