Parasites and Biliary stones

Hepatolithiasis ٨٨
Clinical picture:
Intrahepatic stones lead to the syndrome of recurrent pyogenic
cholangitis (Miquel et al., 1998), presenting with abdominal pain, fever,
and jaundice with the typical Charcot’s triad. Jaundice is due to persistent
obstruction of the bile duct, but such an obstruction is usually incomplete.
A typical attack can last for hours to days, with the biliary colic located in
the upper right quadrant. In some cases, the pain is located in the
epigastrium. The severe state of this attack, the Raynold’s pentad which
defined as the onset of hypotension and mental confusion in addition to
Charcot’s triad has a poor outcome. The recurrent pyogenic cholangitis
leads to liver abscess and/or secondary liver cirrhosis (Chijiiwa et al.,
1993).
The clinical course is characterized by recurrent attacks of pain and
cholangitis, requiring multiple operative interventions. The incidence of
residual stones after surgery is 77% and the incidence of recurrent stones
is 15% (Cheung and Lai, 1996).
Diagnosis:
In patients with acute cholangitis, laboratory tests may reveal a
leukocytosis with shift to the left, elevated liver biochemistry and
hyperamylasaemia pattern that may resemble biliary sepsis resulting from
choledocholithiasis. A combination of abdominal ultrasound, computed
tomography (CT) and direct cholangiography complements the imaging
investigation for hepatolithiasis. Abdominal ultrasonography (US) is a
non-invasive imaging method useful for screening in hepatolithiasis. The
stones are seen in the form of strong echoes with acoustic shadows.
(Choi, 1989). CT demonstrates the extent of ductal dilatation and liver
damage, such as abscess formation, relative atrophy and the hypertrophy