Primary cholesterol hepatolithiasis

Abstract

Stones extracted from patients with hepatolithiasis were analysed by infrared spectrophotometry. Cholesterol stones containing 70% or more cholesterol were found in 12 out of 55 cases. Judging from the lodging site of the stones, the degree of dilatation of the cystic duct, and the presence of cholecystitis, five of the cases were considered to be cholesterol stones produced in the liver. Two out of the five cases were a 44-year-old female and a 46-year-old female, respectively, with normal bifurcation of intrahepatic ducts, and stones were found in the lateral branches of dilated cystic bile ducts. The other three were 2 males and 1 female with an average age of 33. In these cases, the posterior descending branch bifurcated from the left hepatic duct, and stones were lodged in the dilated bile ducts distal to the junction of the left hepatic duct and the posterior descending branch. It is our conclusion that at least the former two were cases of "primary cholesterol hepatolithiasis" in view of the shape of the stones conforming to the hepatic duct, their easy morcellation, and the high cholesterol contents.

Histological evaluation of the intrahepatic biliary tree in intrahepatic cholesterol stones, including immunohistochemical staining against apolipoprotein A-1

“…In contrast, intrahepatic cholesterol gallstones are found in the peripheral intrahepatic bile ducts (9). These cholesterol stones do not migrate from the gallbladder but rather are presumed to be formed mainly in the intrahepatic biliary tree (8)(9)(10). The prerequisite for cholesterol stone formation in the gallbladder is believed to be the presence of cholesterolsupersaturated bile or lithogenic bile (19,20).…”

“…In contrast, cholesterol stones are said to be rare in hepatolithiasis. However, several groups of investigators (8)(9)(10) have reported increased incidences of cholesterol stones in hepatolithiasis and described the mechanism of their formation in the intrahepatic biliary tree.…”

Endoscopically Removed Hepatolithiasis Associated with Cavernous Transformation of the Portal Vein and Antiphospholipid Antibody Syndrome

“…However, several investigators [17,18] have recently reported an increased incidence of cholesterol gallstones in hepatolithiasis. Intrahepatic cholesterol gallstones are found in the peripheral intrahepatic bile ducts [17].…”

“…However, several investigators [17,18] have recently reported an increased incidence of cholesterol gallstones in hepatolithiasis. Intrahepatic cholesterol gallstones are found in the peripheral intrahepatic bile ducts [17]. These cholesterol stones do not migrate from the gallbladder but are believed to be formed within the intrahepatic biliary tree [17,18].…”

“…Intrahepatic cholesterol gallstones are found in the peripheral intrahepatic bile ducts [17]. These cholesterol stones do not migrate from the gallbladder but are believed to be formed within the intrahepatic biliary tree [17,18]. The prerequisite for cholesterol stone formation in the gallbladder is believed to be the presence of cholesterol supersaturated bile or lithogenic bile [19].…”