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KMID : 0371319840260060775
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Journal of the Korean Surgical Society
1984 Volume.26 No. 6 p.775 ~ p.782
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Clinical Experience of Intrahepatic Lithiasis with Severe Complication
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Abstract
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Biliary tract stones were divided into several groups according to its location.
Intrahepatic lithiasis is the condition that stones situated promixal to the origin of the common hepatic duct.
It is difficult in diagnosis, treatment and unfavorable in prognosis, compare with other biliary tract stones.
If it is treated incompletely or ignored by the miss-diagnosis during operation, severe progressive complication and even death may enfaced.
We experienced extremely complicated 6 cases of intrahepatic lithiasis. Among them, 4 cases were treated inadequately due to patient´s poor general condition for extensive surgery or miss-diagnosis of intrahepatic stones. They were treated in a temporary measurement such as only pus drainage procedure or T-tube choledochostomy with lefting primary intrahepatic stones in situ. Eventually severe septic complications were progressed and resulted to death in 2 cases. Another 2 cases who need multiple staged operation after recovery of patient´s general condition were successfully treated with repair of biliary-enteric fistula after complete removal of intrahepatic duct stones and dilatation of stenotic segment of biliary tree. The other 2 cases of intrahepatic stones which were found by active and agressive procedure with table cholangiogram and choledochoscope before and during operation were successfully treated by either segmentectomy or left lobectomy including stones and stenotic biliary tree.
With these clinical experiences, surgeons have to do their best to detect and remove the intrahepatic duct stone completely in first operation of patient and the surgical procedure of entire eradication of stenotic or dilated biliary tree with either segmentectomy or lobectomy seemed prefer method for these complicated and long standing distress of biliary tract diseases.
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KEYWORD
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