Surgical management of refractory hepatolithiasis

ABSTRACT

Hepatolithiasis, or intrahepatic bile duct stones, is a condition characterized by the formation of calculi within the bile ducts of the liver. It is prevalent in Southeast Asia but rare in Western countries. Complications include recurrent biliary colic, jaundice, and cholangitis, potentially leading to liver abscesses and secondary biliary cirrhosis. This case report discusses a 42-year-old Asian man with a history of choledocholithiasis and hepatic cholelithiasis, presenting multiple times with obstructive jaundice and ascending cholangitis. Despite multiple ERCP procedures and sphincterotomies, CT imaging revealed persistent intrahepatic lithiasis confined to the right hepatic lobe. The patient underwent right hepatectomy and Roux-en-Y hepaticojejunostomy. His postoperative course was uneventful, with rapid recovery and successful follow-up. Hepatolithiasis management is challenging due to high recurrence rates and complex treatment requirements. Risk factors include bile stasis, infections, biliary anomalies, and dietary habits. This case underscores the importance of comprehensive surgical intervention, meticulous preoperative planning, and multidisciplinary care for managing refractory hepatolithiasis. Effective management of refractory hepatolithiasis involves advanced surgical approaches and long-term follow-up to prevent recurrence and improve outcomes. Future research should focus on novel therapeutic strategies to enhance patient care.

Keywords: General surgery, hepatolithiasis, hepaticojejunostomy, refractory, biliary pathology