Hepatolithiasis: Present status

In contrast to ordinary cholesterol cholelithiasis, hepatolithiasis or intrahepatic calculi pose serious health problems not only in Japan but also in China, Taiwan, Korea, the Philippines, Malaya, Singapore, and Indonesia. Soft brown calcium bilirubinate stones are present in the grossly dilated intrahepatic bile duct distal to a stricture. Liver lobes involved become fibrous and contain large cysts filled with stones. The classification of hepatolithiasis based on prevailing pathological findings is presented. Two main factors, bile stasis and bacterial infection, are thought to be responsible for the formation of intrahepatic calculi (calcium bilirubinate stones). Β‐glucuronidase from bacteria such asEscherichia colipresent in intrahepatic ducts hydrolyzes bilirubin diglucuronide to bilirubin. The bilirubin combines with the calcium in bile to form calcium bilirubinate which leads to the formation of intrahepatic calculi. The presence of bile stasis, due to bile stricture, aids growth of intrahepatic calculi and aggravates bacterial infection in situ. The clinical picture and the diagnosis and treatment of hepatolithiasis are discussed with emphasis on the recently introduced diagnostic imaging techniques of the hepatobiliary system. Also the principle and practice of operative procedures employed by hepatolithiasis are presented.