Hepatolithiasis is the presence of bile duct stones within the intrahepatic bile ducts, specifically proximal to the confluence of the right and left hepatic ducts.
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Epidemiology
Hepatolithiasis is common in Asia and the Pacific, with a prevalence of ~40%. It is rare in the West with a prevalence of ~1% 1. Primary disease is common in the 5th and 6th decades 4.
Associations
postoperative biliary strictures
Clinical presentation
Triad of abdominal pain, fever, and jaundice. Some patients can be asymptomatic 4.
Pathology
Hepatolithiasis is commonly due to the combination of bile stasis, cholangitis, malnutrition 2,3, and parasite infestation. It can occur with or without the concomitant presence of cholelithiasis or choledocholithiasis.
Etiology
Risk factors include:
recurrent pyogenic cholangitis: the most common predisposing factor
intrahepatic cholangiocarcinoma: poor prognosis
Radiographic features
Refer to: cholelithiasis and choledocholithiasis.
Treatment and prognosis
The primary therapeutic options for hepatolithiasis are hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL).
Complications
biliary cirrhosis: in long standing cases
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