55 consecutive patients with intrahepatic biliary tract calculi treated at the Gospel Hospital in Pusan,
Korea, from September, 1966 to August, 1971, were studied.
Of 350 patients treated for biliary tract caculi, 15.7 percent were found to have intrahepatic stones.
The majority of these patients were in the second and third decades.
Symptoms and signs suggesting intrahepatic calculi included dull epigastric pain, indigestion and anor
exia, colicky right upper quadrant pain, fever and chills, right upper quadrant tenderness, and jaundice.
Leukocytosis, elevated bilirubin, and duodenal aspirate bile pigments or sand were found in the majority
of these patients. An increased alkaline phosphatase was found in 90.2 percent.
Suspicion of biliary tract disease was confirmed in 28 cases by oral cholecystograms and 6 patients by
intravenous cholangiography. Operative or percutaneous transhepatic cholangiography accurately demonstr
ated the pathology in 12 cases.
The importance of intraoperative inspection of the liver cannot be overemphasized. In the majority of
cases, multiple nodules, whitish miliary patches and/or microabscesses were found.
28 patients were treated by cohledocholithotomy and T-tube drainage. Most of these were done early
in this series. This procedure is still used in severely debilitated or septic patients, and the 2 deaths occ
urred in two such patients. Our procedure of choice is now an extended hepatico-jejunostomy (Roux-
en-Y), particularly when strictures and cystic formation are found in the intrahepatic ducts. This has
been performed in 12 patients. The occurrence of cholangitis in two of the 9 patients treated by chole
docho-duodenostomy has led us to favour the Roux-en-Y by-pass.
Hepatic lobectomy may occaionally be necessary for severe intrahepatic disease and was performed in
6 patients.
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