J.Jpn. Surg. Soc.. 87(9): 945-948, 1986

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Report on the annual meeting

HEPATOLITHIASIS

Much attention has been paid recently to hepatolithiasis or intrahepatic calculi because of its intractable course. Incidence of hepatolithiasis differs considerably from area to area in the world and also within Japan. The classification of hepatolithiasis based on the prevailing pathology has recently been proposed. Two main factors, bile stasis and bacterial infection, are thought to be responsible for the formation of intrahepatic calculi. β-glucoronidase from bacteria such as Escherichia coli present in intrahepatic ducts hydrolyzes bilirubin glucuronides to bilirubin. The bilirubin combines with ionized calcium in bile to form calcium bilirubinate leading to the formation of intrahepatic calculi. Presence of bile stasis, due to bile duct stricture, aids growth of intrahepatic calculi and aggravates bacterial infection in situ. Clinical picture, diagnosis and treatment has been discussed with the emphasis on the recently introduced diagnostic imaging technique such as PTC, ERC, ultrasound and CT. Diagnostic steps from screening to establishment of precise pathology by several diagnostic procedures such as balloon catheter ERC and ultrasound guided PTC have been presented. Operative strategy based on the newly proposed classification from the precise pathology obtained by the improved biliary imaging technique led to the much improved prognosis in recent years.

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