Rare primary intrahepatic lithiasis in a young patient

Abstract

Introduction. Intrahepatic lithiasis (IHL) is a disease that occurs in middle-aged and elderly people. Presentations of IHL in the young are rare, and considerations in the differential diagnosis include primary sclerosing cholangitis, recurrent pyogenic cholangitis, bile acid transporter defect, Caroli’s disease, and other known genetic diseases. Treatment is often complex, all in order to prevent complications. In this report, we describe the diagnosis and treatment, with the application of a flexible ureteroscope of 4 Fr, of a younger patient with intrahepatic lithiasis. Case report. A 25-year-old man appeared with a known diagnosis of IHL and a recurrent attack of abdominal pain that required medical treatment. Magnetic resonance imaging of the abdomen showed segmental stenosis of the left bile duct and segmental bile duct for the lateral section with intraductal calculi and its proximal dilatation and mild dilatation of the bile ducts for liver segments II and III. During surgery, a cholangiography and ultrasonography of the liver were performed. Through choledochotomy, the bile ducts were flushed, and extirpation of the several calculi was performed. The bile ducts were examined with a choledochscope, and the remaining concrements were removed with a flexible ureteroscope. Conclusion. Segmental liver bile ducts may be explored with a flexible ureteroscope without bile duct injury or trauma. In selected cases, with isolated lithiasis in one liver lobe and the absence of concomitant diseases, IHL can be treated surgically without liver resection. This case is unique because we did not perform liver resection but duct stone extraction, which was an appropriate treatment since there was no recurrence during the two-year follow-ups.