Hepatolithiasis and biliary parasites

Joseph Leung, Andy S. Yu

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Hepatolithiasis, or the presence of intrahepatic stones, is prevalent in East Asia and is characterized by the finding of stones within the intrahepatic bile ducts proximal to the confluence of the right and left hepatic ducts. Bile stasis and bacterial infection have been incriminated as the major aetiopathogenic factors. Clinical features include recurrent pyogenic cholangitis, multiple liver abscesses, secondary biliary cirrhosis and cholangiocarcinoma. The goals of management include accurate localization of pathologies, control of biliary sepsis and the elimination of stones and stasis. Ultrasonography, computed tomography and direct cholangiography complement each other in defining the stones, strictures and degree of liver damage. Non-operative biliary decompression by endoscopy and interventional radiology is effective in controlling the infection, but surgery remains the mainstay for the treatment of stones and strictures. Intra-operative ultrasound and flexible choledochoscopy, combined with percutaneous transhepatic cholangioscopy and intraductal lithotripsy, facilitate stone removal. Balloon dilatation and biliary stenting serve to open the bile duct strictures. The creation of a hepaticocutaneous jejunostomy after conventional surgery allows atraumatic access to the biliary system for the removal of recurrent stones. The management of biliary parasites begins with conservative measures, including analgesics and anti-helminthic therapy. In refractory cases or patients with acute cholangitis endoscopic biliary drainage and the extraction of worms may be necessary. Improvement in sanitation plays a crucial role in the epidemiological control of these biliary diseases.

Original languageEnglish (US)
Pages (from-to)681-706
Number of pages26
JournalBailliere's Clinical Gastroenterology
Volume11
Issue number4
DOIs
StatePublished - Dec 1997

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Pathologic Constriction
Parasites
Cholangitis
Therapy with Helminths
Jejunostomy
Intrahepatic Bile Ducts
Common Hepatic Duct
Interventional Radiology
Liver Abscess
Sanitation
Cholangiocarcinoma
Far East
Lithotripsy
Cholangiography
Biliary Liver Cirrhosis
Biliary Tract
Decompression
Bile Ducts
Bacterial Infections
Bile

Keywords

  • Ascaris lumbricoides
  • Cholangiocarcinoma
  • Clonorchis sinensis
  • Endoscopic retrograde cholangiopancreatography
  • Hepaticocutaneous jejunostomy
  • Hepatolithiasis
  • Intrahepatic stones
  • Lithotripsy
  • Percutaneous transhepatic cholangioscopy
  • Recurrent pyogenic hepatitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Hepatolithiasis and biliary parasites. / Leung, Joseph; Yu, Andy S.

In: Bailliere's Clinical Gastroenterology, Vol. 11, No. 4, 12.1997, p. 681-706.

Research output: Contribution to journalArticle

Leung, Joseph ; Yu, Andy S. / Hepatolithiasis and biliary parasites. In: Bailliere's Clinical Gastroenterology. 1997 ; Vol. 11, No. 4. pp. 681-706.
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