A 53-year-old man presented with a common hepatic duct stone and was also found to have an incarcerated stone, which was thought to consist of cholesterol, in the intrahepatic bile duct of the right lobe. After operative choledocholithotomy, removal of the intrahepatic cholesterol stone was accomplished with percutaneous cholangioscopic lithotomy (PCL) via a choledochal drainage route after pneumatic balloon dilation of a stricture, followed by internal stenting. Although case reports of primary cholesterol hepatolithiasis with some characteristic clinical features have increased recently in Japan, the natural history and clinical course after nonsurgical intervention remain uncertain because of the rarity of this disease entity and lack of long-term follow-up studies. We concluded that intrahepatic cholesterol stones can be removed with percutaneous cholangioscopic lithotomy (PCL) without hepatectomy because ductal inflammatory changes and liver parenchymal atrophy, which are indications for surgical intervention, are seldom encountered in primary cholesterol hepatolithiasis.
Satoh et al. (Thu,) studied this question.