Retka primarna intrahepatična litijaza kod mladog bolesnika
Sažetak
Uvod. Intrahepatična litijaza (IHL) je bolest koja se javlja kod osoba srednjeg i starijeg životnog doba. Pojava IHL kod mladih osoba je retka, a diferencijalna dijagnoza uključuje primarni sklerozirajući holangitis, rekurentni piogeni holangitis, defekt transportera žučne kiseline, Karolijevu bolest i druge poznate genetske bolesti. Lečenje je često složeno, sa ciljem da se spreče komplikacije. U ovom radu prikazujemo dijagnozu i lečenje bolesnika mlađeg životnog doba sa IHL korišćenjem fleksibilnog ureteroskopa promera 4 Fr. Prikaz bolesnika. Muškarac star 25 godina, sa ranije poznatom dijagnozom IHL i ponavljajućim napadima bolova u stomaku koji su zahtevali medicinski tretman, javio se na pregled. Magnetna rezonanca abdomena pokazala je segmentnu stenozu levog žučnog kanala i segmentnog žučnog kanala za lateralnu sekciju sa intraduktalnim konkrementima, kao i proksimalnom dilatacijom, te blagu dilataciju žučnih puteva za II i III segment jetre. Tokom operacije urađeni su holangiografija i ultrazvuk jetre. Žučni kanali su isprani kroz holedohotomiju i izvršena je ekstirpacija nekoliko konkremenata. Pregled žučnih puteva urađen je holedoskopom, a preostali konkrementi su uklonjeni fleksibilnim ureteroskopom. Zaključak. Segmentni žučni kanali jetre mogu se eksplorisati bez traume fleksibilnim ureteroskopom. U odabranim slučajevima, kod izolovane litijaze u jednom režnju jetre i odsustva pratećih bolesti, IHL se može lečiti hirurški, bez resekcije jetre. Prikazani slučaj je jedinstven jer nismo uradili resekciju jetre, već ekstrakciju konkremenata iz žučnih kanala, što je bio odgovarajući tretman, imajući u vidu odsustvo recidiva tokom dvogodišnjeg praćenja.
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